Commitment from the top
It may be one of the most-used clichés that any initiative undertaken at a hospital must have the mandate of the highest-levels of clinical and executive leadership to succeed. But saying that and meaning can that drive two different results and this is "where a lot of EDs fail," says Assaad Sayah, chief of emergency medicine at Cambridge Health Alliance.
Sayah says engineering something like patient throughput in the emergency department often requires "heavy lifting" in many departments that connect to the ED.
"This is basically where a lot of EDs fail," Sayah says. "Any ED can re-engineer their front end but it takes an institutional commitment to work on the throughput piece. And without that, it will fail."
One example for leadership having a stake on an issue like throughput is "code help," an alert system CHA put in place that allows for a clinical manager to call for help when the ED is clogged.
"Everybody gets called all the way from the administrator to the CEO, CMO, CNO and housekeeping," Sayah says. "It's all hands on deck. The idea is within 30 minutes the admitted patients will leave the emergency department and go upstairs to the floor."
The benefit is not just in the immediate fix, and the code is only used maybe twice a year, Sayah says. Knowing that leadership is available to help manage the situation has its own real and symbolic benefits.