Improving Patient Flow in the ED

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Healthcare organizations are doing battle across many fronts on a daily basis. One of the most prominent fronts is found in the emergency department with patient flow.

FierceHealthcare recently asked the following question of two industry leaders: “How can hospitals keep EDs running smoothly?” Their answers can be broken down into four strategies.

First, start evaluation early.

“In the ED, input has a huge influence on throughput,” the article observes. “But by concentrating on front-end strategies, hospitals can ensure patients experience a smooth and timely emergency visit.”

Jesse Pines, director of the Center for Healthcare Quality at George Washington University and associate professor of emergency medicine and health policy in Washington, D.C., summed this concept up nicely. “When patients start their care earlier, it ends earlier.”

Pines “recommends having physician-in-triage, which allows a physician to immediately evaluate patients in the triage area and order appropriate tests, as well as quickly discharge patients with minor conditions.”

This can prove beneficial during those hard-to-manage peak hours. Furthermore, replacing traditional triage and registration with rapid assessment can aid efficiency at the front end.

Second, use space quickly and wisely.

ED overcrowding is an ever-present concern for hospital officials. Many blame the space they have as being too limited. As FierceHealthcare writes, “…that doesn’t mean a hospital needs more space; rather, ED leaders must make better use of the space they have.”

“Fast-track” methods that are centered on efficient ED service to low and mid-acuity patients will help with time issues. Pines said that “hospitals should stream patients with similar needs [into the same area] to ensure safe and quick turnover.”

One way to create these fast-track methods is with internal waiting rooms. Pines believes “internal waiting rooms have the ability to flex up and down based on census and can provide space for patients to wait for their test results and then be discharged or admitted.”

Third, ensure hospital-wide collaboration, support.

The whole hospital, from the leadership on down, needs to take responsibility for ED efficiency, James Schweigert, M.D., medical director of emergency services at Spectrum Health System, said. It must be a “hospital-wide issue.”

Schweigert adds, “We need all of our ED resources, hospital resources, and community resources to improve care.” He recommends that “leaders in other departments conduct ED rounds during peak demand so they can see the problems firsthand.”

Finally, understand that metrics matter.

Pines asserts, “It is impossible to know what the problem is in a specific hospital, and whether interventions are working, without good data and metrics…[ED improvement strategies require] a continuous and sustained effort over a long period of time to try new changes and see what works best in a local setting.”

You need data and you need clear organizational priorities for this, he adds. This could include “data check-ins to identify safety, flow, and capacity concerns and adequately address them,” Schweigert said.

“The best practices included using electronic data systems to track frequent ED users and exchange information regarding their care,” the article concludes. “Hospitals also assigned employees to review and provide feedback reports on ED utilization data to monitor their progress.”

What is your opinion of the ideas put forth in this article? How have you and your organization improved patient flow in the ED?

-by Pete Fernbaugh

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