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Throughput and Satisfaction in the ED

Michael Zeis, for HealthLeaders Media, May 15, 2014

While many functions of the emergency department must be reactive in nature, with proper preparation, an effective response can ensure optimal outcomes.

This article appears in the May 2014 issue of HealthLeaders magazine.

While many functions of the emergency department must be reactive in nature, with proper preparation, an effective response can ensure optimal outcomes.

Much of what happens in the emergency department is related to how many and what kind of patients come through the doors. And while patient volume and acuity may be predictable, to an extent, for the most part, those are factors that the ED team cannot fully control. But with proper preparation, an effective ED response can ensure optimal outcomes, improved patient satisfaction, and efficient throughput with reduced wait times.

"I divide factors that contribute to wait times into two categories: those which the ED can control and those which it can't," says Darren Shafer, DO, the service line medical director of emergency medicine, urgent care, and the Albuquerque (N.M.) Ambulance Service for the eight-hospital, Albuquerque-based Presbyterian Healthcare Services.


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One-quarter (25%) of the respondents to the HealthLeaders Media 2014 ED Strategies Survey report annual visits in excess of 70,000 patients. That includes 43% of health systems but only 17% of hospitals. Facility size certainly is a factor: More than half of large hospitals (51%) see more than 70,000 patients per year in their EDs. Overall, more than half (55%) say their ED is always or often overcrowded, and size, again, is a factor: 71% of respondents with net patient revenue of $1 billion or more say their ED is always or often overcrowded.

Longer wait times are one consequence of overcrowding. While one-fifth of all respondents (19%) report an average time patients spend in the ED before being seen by a healthcare professional of less than 15 minutes, in EDs characterized as always or often overcrowded, the average time patients spend in the ED before being seen by a healthcare professional is 46 minutes. In EDs characterized as occasionally, rarely, or never overcrowded, average waits are 23 minutes.

Because there is an element of unpredictability about patient volumes, there also is an element of unpredictability about wait times. But unlike patient volume, there are many ways to address wait times. Here's why ED leaders pay a lot of attention to wait times: "Even if a patient is not back in a bed, for instance, if they're in our waiting area and not being seen by a doctor, they're still our responsibility," says Judy Horton, RN, director of emergency services for the 726-bed Texas Health Harris Methodist Hospital Fort Worth.

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