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Bleeder to Feeder: How an ED Turned Its Business Around

Philip Betbeze, for HealthLeaders Media, March 11, 2011

It was probably the biggest priority for his predecessors too, but they couldn't get it fixed, despite the fact that prior to the latest re-engineering exercise led by Davis and Charlton leaders themselves, three separate consultants hired to fix the problem failed.

It wasn't because they weren't competent, says Davis, who, of course, wasn't around when they did their work. Rather, it was that no one knows the reasons why an ED isn't working properly better than the people who work there and elsewhere in the hospital.

"We placed so much focus on the ER, but we couldn't fix the problem because it was really an organizational issue," Davis says. "We had to get everyone involved."

He found new leadership for the ED. He formed a committee to recommend process changes that included nurse directors, all the administrative leadership, the case management employees and two key physicians. He sent all members of the administrative staff to work in the ED at various times in order to observe and understand the problems faced by the people working in moving their patient load through the ED efficiently. One lesson learned meant that they added a physician in triage to deal with the 30% of cases in the ED that were non-emergent.

"You've already seen the patient and ruled out the emergency, so treat them and let them go rather than sending them back to the waiting room," he says. "If we send them to the waiting room, that's a failure on our part."

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