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Split ED Flow, Watch Your Bottom Line Grow

Karen Minich-Pourshadi, for HealthLeaders Media, April 2, 2012

"We have 34 beds. If we stayed with the old process, I'd have one bed per patient and that doesn't work when you need to see 94,000 patients a year. We were able to increase our productivity, decrease our risk, and decrease our costs," she says. "Plus everyone was happier: the patients, the physicians, and the nurses."

Banner Estrella has come a long way from the 6-8–hour wait times in 2004. Now on the ED's worst day, the average wait time is 36 minutes. Overall patient satisfaction scores for the ED average 86%. And the department has won national awards for quality care for three years in a row.

Plus, the split flow model has a quick financial ROI. "Initially, doing this required a few more resources for redesign and staff, because we had to create separate areas for intake, quick look, and continuing care. But we gained better throughput, patient satisfaction and safety," Johnson-Kelley says. "This gave us the ability to bed acute care patients immediately and that far exceeds any amount we spent.,"

Editor's note: For more on the split flow model, check out the HealthLeaders Media webcast Lower Costs, Better Productivity in Your Emergency Department, in which Johnson-Kelley and other ED innovators will answer subscriber questions on how to turn around ED operations.


Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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3 comments on "Split ED Flow, Watch Your Bottom Line Grow"


dmmitchell (4/6/2012 at 3:38 PM)
People come to the ED because they have are distressed or diseased. The Latin root of the prefix means discomfort with...something that all of us who work in the arena need to remember. Having worked as a RN in EDs for the past 25 years, I have some insight into both the process of the ED and as a consumer of how it feels to be either the patient or the patient's loved one. All patients should be greeted promptly, their anxieties acknowledged, and be informed of what will happen and approximately how long things will take, barring the unforseen. Will we satisfy every need of every individual? Of course not, but a little kindness and anticipation of what the presenting people are going through goes a long way. It is often the most basic things that are forgotten and it is the many small things that satisfy patients.

Kahlan (4/4/2012 at 5:22 PM)
Ms. Minich, I agree completely with Josh. One of the reasons Emergency Departments get backed up is that the majority of kids we see do not need "emergency" care. Parents need to educate themselves better on what truly constitutes an emergency. A toddler with a 102ยบ fever does not, especially if it has lasted less than 24 hours. A child who is vomiting for less than 24 hours does also not constitute an emergency. Yet every time a child with an ear infection, pink eye or some other minor condition is brought to the ED rather than their own primary care physician, it takes up bed space and time for the patients who really DO need to be seen quickly. There is a finite number of beds in every ED and a limited number of staff to attend to them. Perhaps you would serve your readers better by educating them on which provider to see rather than slamming the hospital who didn't get you in and out in your preferred time. An ED is not a McDonalds.

josh (4/2/2012 at 5:35 PM)
Ms. Minich, I'm sorry your son was ill recently. But you went to an ER for a kid with a fever. An ER is there for gun shots, car crashes, heart attacks, etc. I don't know how sick or well your child may have been. But did you reach out to all the other places that would have given you as good or better care and would have provided as good or better satisfaction? Did you call your pediatrician or family doctor for telephone advice first to see if any immediate medical attention was needed? Did you go to an urgent care center or walk-in rather than a hospital ER? Does your pediatrician/family doc have extended evening and weekend hours? All of these might have gotten you faster more personal service. You asked, "why didn't the first nurse give us the diagnosis?" Because nurses don't make or give diagnoses, doctors (or nurse practitioners) do. "Why did we have to wait so long before being seen?" Because there are other sick patients who need the attention of medical care more urgently. "Why did it take 90 more minutes before we were sent home?" Maybe because it takes time to see if nausea medicine works and whether more interventions would be needed. Odd conclusions you draw. When people come to my ER and are disappointed, they think poorly of the ER and of ER's in general. They don't think poorly of the entire hospital or the entire health organization that owns it.