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4 Ways to Accelerate ED Triage, Boost Revenue

Joe Cantlupe, for HealthLeaders Media, October 13, 2010
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When HVHC initiated a program in 2005 to speed up review of patients in the ED waiting area, the average time for patients to be evaluated by a medical practitioner dropped by 47%—just one month after the initiative began. Since then, the hospital has gradually reduced waiting times. Federspiel says he attributes an increase of patient volume in the hospital—about 20%—to improvements in the ED.

Having a speeded-up ED process is something "we take advantage of," he says. "We have a half-hour distance from our competitors. People have a choice where to go for their ED treatment. We're doing this because people are voting with their feet."

Success Key No. 1: Decreasing walkout rates

One of the major problems for emergency departments has been dealing with the "walkout rates"?potential patients who grew frustrated waiting in the ED and decide to go home or to another facility. The longer the patient waits, the more likely he or she will leave without treatment, resulting in potential problems for the patient as well as lost income for the hospital.

The Scripps Mercy Hospital, a 700-licensed-bed facility, focused making ED improvements that included targeting the walkout rates. By effectively separating patient groups, by illness, for example, the hospital has reduced the number of walkout rates. In June 2009, the patients who left without treatment were 253; that figure was reduced a year later to 11 in June 2010.

 "People were sitting in the waiting room and got fed up," says Norton. At one point, 5% of patients were leaving the ED between July 1, 2009, and February 23, 2010; the hospital has decreased that total to 0.4% between February 23, 2010, and June 30, 2010.

The result has been more patient volume in the hospital "because we've been able to get more patients in, and ambulances that used to be diverted away from the hospital are no longer diverted," she says. "The word has gotten out to the community, and more people are showing up. And that is a savings, too, with the ambulances no longer being diverted."

At the Scripps Mercy ED, patients seeking treatment are immediately assessed by a nurse who determines whether the patient requires a bed or recliner, depending on the severity of the case. When a bed or recliner is available, the patient is taken back to the designated area immediately.  

"The biggest challenge was getting rid of the up-front wait," she adds. "In the old traditional way, you'd be in bed for two hours. Now we are taking people out of the beds and have them in chairs. We are turning over the beds rapidly for people who really need them."

Such movement is important, she says, because "really sick patients account for only 30% of the volume" in emergency departments. "Patients are served very poorly by having to wait in waiting rooms."

Success Key No. 2: The asthma lounge

After studies in Oakland, CA, that showed more than the usual number of cases of asthma, Alameda County Medical Center, a 236-licensed-bed facility, established a specialized unit for asthma patients that hospital officials say has resulted in improved overall outcomes for asthma sufferers as well as reduced wait times for other patients in the ED.

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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.