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4 Ways to Accelerate ED Triage, Boost Revenue

Joe Cantlupe, for HealthLeaders Media, October 13, 2010
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For a long time, waiting has been almost synonymous with emergency departments in American hospitals.

But hospitals are streamlining their emergency departments to reduce waiting times as EDs continue to be swamped with increasing numbers of patients.

In 2009, Americans averaged 4 hours and 7 minutes in ED waiting rooms before being seen. And more people are expected to be crowding into EDs over the next several years. Emergency visits may increase as much as 5% to 10% over the next several years in the wake of the healthcare reform law.

Waiting in the ED often has a negative impact on patients' attitudes, with many simply deciding to leave the hospital, despite needing care, and despite the likely consequence of poorer health outcomes. The unfolding scenario has a potentially detrimental impact not only on the patients themselves, but also on overall hospital business.

To meet demands of patients, hospitals are working diligently to ramp up services and decrease wait times by restructuring waiting areas, placing nurses and physicians in entrance areas for "fast track" services, evaluating serious and nonserious conditions among patients in the ED, or evaluating specialized conditions, such as asthma, to improve patient flow.

Such innovations not only have improved patient care, but they inevitably feed hospital revenue because patient care usually begins with the ED, hospital officials say. There were nearly 117 million patient visits to the nation's emergency rooms in 2007, a 23% increase over a decade earlier, or 39.4 visits per 100 persons, according to the National Health Statistics Reports.

By making improvements to the ED, "there has been a positive impact even though the emergency department is not a money maker, per se," says Valerie Norton, MD, medical director for the ED at Scripps Mercy Hospital in San Diego. "You can't look at it in isolation as a separate silo. It's a feeder of inpatients for the hospital. Urban EDs are admitting 20% of the patients who come through the ED. It's very good revenue for the hospital and we are able to increase the volume."

Hospitals also are under increasing pressure to improve EDs, not only because of the need to serve additional patients but also because of the competitive nature of the services, says John Federspiel, MBA, president and CEO of the 128-staffed-bed Hudson Valley Hospital Center in Cortland Manor, NY.

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2 comments on "4 Ways to Accelerate ED Triage, Boost Revenue"


Jeanne McGrayne (10/13/2010 at 12:16 PM)
Could the author please provide a reference for the 4 hour 7 minute average wait time nationwide? This is not consistent with a number of ED benchmarks available. Thank you

John Murphy (10/13/2010 at 10:14 AM)
Most ER's triage patients using an experienced nurse to assess severity. Our clinical advisor, Dr. Donald Thomas, developed a formulaic, computer assisted application for ER triage. The level of severity is assessed using hospital developed measures and the chief complaint invokes diagnostic protocols prior to the patient registration. The typical result is a "one touch" visit by the ER physician usually resulting in reduced throughput by at least an hour. We are looking for early adopters.