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Lower ED Margins Demand a Better Strategy

Margaret Dick Tocknell, for HealthLeaders Media, May 24, 2013

Overcrowding
As demand for ED services increases, more healthcare leaders describe their EDs as overcrowded. While 46% of respondents described their ED as being overcrowded in our 2012 ED survey, 61% do so in this year's survey. Overcrowding exacerbates some common ED challenges. About one-third of respondents (32%) said patient flow is the greatest challenge facing their ED, wait time was mentioned by 15%, and patient boarding by 13%.

Survey respondents cite a number of effective ED operations techniques to improve ED throughput: fast-track area for lower acuity (61%), triage medical evaluation process (58%), and streamlined registration process (53%).

Systemwide issues also cause headaches for the ED. "The ED only flows as well as the hospital flows," says Leon L. Haley, MD, deputy senior vice president for medical affairs and chief of emergency medicine at Grady Health System in Atlanta. "On some level, we've done ourselves a disservice by talking about ED overcrowding. We should be talking about hospital crowding and hospital flow."

Depending on the ED issue at hand, Haley says the throughput committee at Grady might consider environmental services staffing and room cleaning, radiology department staffing and testing hours, physician staffing, lab processes and structure, and possibly guest services and transportation. "It's all tied together," he says.

Bottleneck
About three-quarters of healthcare leaders (73%) identified ED-to-inpatient transfers as the biggest bottleneck for ED flow. "Keep in mind that every time you delay a discharge upstairs for an hour, it backs up in the course of the day and can be a two- or three-hour delay for the ED, says Marlon Priest, MD, executive vice president and chief medical officer for Marriottsville, Md.–based Bon Secours Health System, a 19-hospital system that serves seven states.

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