Strategies for Improving ED Throughput
It’s 7 p.m. and you’ve just been in an accident. Nothing serious, but you think your ankle is sprained. You decide to go to the emergency room. Upon entering the ER, you see EMTs wheeling in patients on gurneys with oxygen. As you continue into the waiting room, you hear someone mention a multicar accident. You look around for a seat, but the waiting room is crowded. As a stable patient, you might be in for a long wait.
It’s no secret that longer emergency room waiting times can lead to worse patient outcomes and lower patient satisfaction scores. In this critical department of the hospital, each moment can mean the difference in the life of the patient.
Although it varies widely by geographic location, the national average patient wait time in the emergency room before seeing a doctor is 24 minutes. Improving ED throughput can be accomplished by instituting several changes in the hospital ED setting.
The Institute of Medicine (IOM) released a report last year that detailed the major causes of the emergency room wait time problem in hospitals. In the report, they identified several contributing factors including:
- mismatched supply and demand
- care and reimbursement complexity
- financial and geographic barriers
Using examples from our current clients, Medisolv has pulled together some best practices to help you improve your ED throughput time. We have also included some strategies outlined by the Agency for Healthcare Research and Quality (AHRQ).
Form a Patient Flow Team
If your hospital does not currently have a designated patient flow team, now is the time to institute one. This multidisciplinary team is used to plan quality improvement interventions. The AHRQ recommends that this team include a team leader (i.e., day-to-day leader), senior hospital leader (e.g., chief quality officer), ED physicians and nurses, ED support staff (e.g., clerks, registrars), representatives from inpatient units and a research/data analyst. Forming this team will allow representatives from each affected unit to have their voice heard and will also send a clear message to all staff that the hospital is making ED throughput a high priority in your hospital.
When checking in ED patients, have the hospital staff gather limited information to get them into the HIS. We suggest forming a greeter team, which might include a clinician and a registration clerk. Have the registration clerk ask the patient three to four identifying questions to receive the patient. Have the clinician administer a short nursing assessment. This alleviates one facet of patient wait time and gets all patients in HIS quickly.
Create patient areas based on needs
Many hospitals are implementing strategies to address patients that have less-urgent conditions such as a sprained ankle. A Fast Track area will allow these patients to be quickly seen by a nurse practitioner or physician assistant. Other hospitals have instituted a Rapid Medical Exam area, where patients can be seen by a physician, have blood work drawn and X-rays ordered all while waiting for a bed.
Focus on the Patient
Change the hospital’s focus to patients. Ask your patients for feedback to help you understand what matters to them. Hospitals are incorporating new methods of gathering feedback by including survey portals in various locations throughout the hospital. Other hospitals are allowing patients to schedule their own ED appointments for less-critical issues. There are a wealth of tools out there now that allow hospitals to display ED wait times to patients before they arrive, which prepares the patient or allows them to consider other hospital options.
Monitor ED Performance
Using a technology solution, like Medisolv’s RAPID software, to monitor and analyze ED throughput is critical for improvement. We recommend monitoring these six key time points.
- Patient in Room
- Seen by Doctor
- Decision to Admit as Inpatient or Depart from ED
By monitoring these time points, you can assess the time interval between each step. Clearly documenting these time points is the first step to improving ED throughput.
Take Advantage of Technology Functionalities
If you are currently using MEDITECH EDM Module, we advise that you use the Auto Advance Function as often as possible. This included function ensures that your patient is moved to the next EDM status as soon as a certain action takes place. For example, when the Receive Function is filed – auto advance status event to RECEIVED. When the Triage Assessment is filed – auto advance status event to TRIAGED.
Analyze Your Reports
Of course, merely monitoring your performance across those time points is not enough. Your hospital executives will want to see these time points in a comprehensive report. It’s important that no matter what tool you are using, that you have access to reports that display your ED times. RAPID, for example, features a dashboard at the highest level that displays all of those key time points in a rolling 12-month period. There are multiple other reports that allow for more detailed analysis such as:
- Patient Detail
- Length of Stay by Discharge Disposition
- Key Time Points by Physician
- Wait Time from Decision to Admission
Get Executive Buy In
Leadership at every level of the health care delivery system is essential to sustain the cultural and operational changes needed to improve ED throughput in your hospital. Make sure that your executive team understands why this is critical. With executive buy in, your hospital will be more willing to invest the financial and staffing requirements needed to make improvements.
Medisolv offers a software solution to monitor and improve your ED throughput times. Our clinical consultants work with your hospital to set up an effective suite of ED reports customized for your hospital. They also provide expert consultations to help your hospital improve. Talk to us today about our RAPID software solution to improve your ED throughput results.
Adrienne is a Senior Consultant on the abstracted measures team for Medisolv.