Is it the flu, COVID-19 or a combination of both that’s contributing to the looming threat of busier than usual hospitals? Here’s how to use data to prevent an overcrowded emergency department.
People already refer to it by many hair-raising nicknames. “Double Threat,” “Double Whammy,” “Double Trouble,” “Duel Infections” and “Twindemic” are a few that come to mind.
The “it” in question is the convergence of the COVID-19 pandemic and this year’s flu season. Where they might converge is in your hospital emergency department (ED).
The official Oct. 1 start to flu season is here and the time to immunize your emergency department from the Twindemic is now, and the most readily available vaccine is data.
Let’s look at some numbers, then do a little scenario planning. I’ll also suggest how you can use data and analytics to successfully manage your ED capacity and patient throughput to help prevent patients with COVID-19, the flu or both from overwhelming your hospital.
COVID-19 and flu by the numbers
The Centers for Disease Control and Prevention estimated that as many as 56 million people in the U.S. got the flu last season, which ran from Oct. 1, 2019, through April 4, 2020. That, according to the CDC, resulted in:
Meanwhile, the CDC reported more than 6.3 million confirmed cases of COVID-19 in the U.S. between Jan. 21 and Sept. 10, 2020. Also:
Yet, hospitals’ overall emergency department volume is dropping because of COVID-19, people are avoiding going to the ED out of fear of contracting the deadly virus. That’s the takeaway from a study published Aug. 2 in JAMA Internal Medicine. Researchers looked at changes in ED visits from Jan. 1 through April 30 at 24 EDs operated by five different health systems in five different states. They found that:
What could go wrong in your emergency department?
No one knows exactly what’s going to happen in your ED when COVID-19 and the flu virus begin affecting the country together. The fact they have similar symptoms will only exacerbate the situation.
Let’s look at some potential scenarios:
Your challenge will be preparing for any of the above scenarios, because any of them could affect your historic emergency capacity and patient throughput numbers, not to mention the strain on your operating costs.
Data may be the best “vaccine”
We all know that the best strategy against the flu is prevention. We should get flu shots, cover our noses and mouths when we sneeze and cough, and we should wash our hands. The best strategy against COVID-19 is more or less the same: Until there’s a vaccine, we should wear masks, maintain social distancing and wash our hands.
It should come as no surprise that when it comes to keeping flu and COVID-19 patients from affecting your hospital’s emergency department throughput the best strategy is also prevention. That prevention starts with data and analytics.
There are a lot of metrics that track ED throughput. Medisolv’s Rapid analytics software includes 17 of key time point indicators. The five most important metrics that all hospital EDs should track are:
Look at your data over the past year (especially during the last flu season) to see where your bottlenecks are in moving your emergency patients in, out or up. The three most common bottlenecks are: Triage to ED In-Room, because your ED beds are full; Seen to Decision, because you’re waiting on test results or to make a diagnosis; and moving patient to the floor after the Decision to Admit, because all your inpatient beds are full.
Drilling down for answers and solutions
Armed with answers from that data, you can start drilling down to figure out what’s causing delays. Is it a particular inpatient unit that never has any beds open? Is it a specific admitting physician? Are you always waiting on a particular diagnostic test?
Conversely, which inpatient units always have a bed available for your ED patient? You can share whatever they’re doing right as best practices with other units. It’s the same with the admitting physicians. What best practices can high performers share with other admitting physicians?
The convergence of COVID-19 and the flu in your emergency department will put stress on all of those throughput metrics, and the time to start looking at your data to make preventive changes in your structures and processes is now, before both COVID-19 and the flu are knocking at your emergency department’s door.
For example, what if you’re going to need more inpatient or ICU beds because you’re expecting to admit more COVID-19 patients if there’s a second wave of the pandemic? That will inflate your Decision to Admit time unless you start rethinking your admission processes now.
If you’re not doing discharges 24/7 now, you should. You may also want to deploy hospitalists to handle all inpatient discharges, rather than waiting on other physicians. Or you may want to have all your discharge paperwork done a day before an expected discharge, so when it does happen, there aren’t any avoidable delays. Be certain to utilize your hospital information system (HIS) to communicate discharges and potential discharges throughout the hospital.
For more ideas on how to improve your ED throughput, read these other blog posts:
Whatever strategies and tactics you plan on using to immunize your emergency department against the Twindemic, it all starts with data. It’s the best preventive medicine.
Medisolv would like to thank Danika Davis, Director of Emergency Services at Granville Medical Center and Melissa Doehrmann, CNO at MercyOne Newton Medical Center whose insights helped shape this blog article.
With flu season upon us, it's important to stay "in the know" of how to best care for patients. Here are some resources you may find useful. On-Demand Webinar: "New eCQM Requirements for the 2021 IQR Program" |