ED Management Strategies Linked to Revenue Recovery

Cutting just one hour off the boarding time results in better care for the patients and higher profits for the hospital, he says. Nationally, 10% to 15% of the time patients spend in an emergency room is spent waiting for a room after they are admitted, or "boarding," Pines says.

Additionally, ED boarding time, total time spent in the ED, left-without-being-seen rates, and other quality metrics specific to emergency room performance will soon be posted on Hospital Compare, giving patients another basis on which to choose where they get their care.

To streamline ED flow, however, research by Pines shows that hospital teams would have to agree to place some patients on units that they wouldn't ordinarily go to. For example, there might be a general medicine unit bed available, but the physician wants the patient to go to a GI floor, a practice that means the patient has to wait longer, boarding in the ED. Hospital teams might also have to agree to remove limits or thresholds on the number of hospital beds reserved for ED patients.

It also would mean that on occasion, hospitals would postpone a few elective surgeries – roughly about 5% – or reduce scheduling on certain days of the week when ED volume is usually highest, such as on Mondays and Tuesdays. Physicians may not like that, he acknowledges, but "you'd have to have an understanding among physicians and certain management that certain cases might be cancelled and patients inconvenienced." 

Not scheduling those procedures in the first place on those days would resolve some of the crunch.

The research was done as a simulation exercise at a sample inner city teaching hospital with 118,000 ED visits, from which 22% were admitted over two years, and 7% left without being seen.