Hospitals also must work "externally" to improve the EDs, she says. "Cross dialogue between hospitals would advance collaboration and problem solving in these and other areas; however this has not been explored because most institutions work in silos."
"As hospital leaders evaluate [a hospital’s] throughput agenda, they must not only evaluate crisis situations, but the continuum of care that begins in the ED," Bullock adds.
She is hopeful in the process that Providence officials have initiated. "The fact that a community hospital has taken such an interest in improving the ED services means that upper level administration ‘gets it’ in terms of the importance of the service delivery in the ED. There is a bottom fiscal line here, which many hospitals recognize but still do not prioritize in the way that they should," Bullock says.
Physician involvement is crucial to transform any ED, but the responsibility rests not only with those who work there, Bullock emphasizes. Surgeons, specialists and primary care physicians assigned elsewhere in a hospital must play a role. ED delays, patient satisfaction, and performance measures are all tied together,
"Attitudes must change generally. That's not just an ED problem mentality, but a hospital problem," Bullock adds. "And unless everyone becomes involved, everyone loses."