Addressing Emergency Department Flow, Inside and Out

Michael Zeis, May 18, 2015

"We are the masters of unscheduled care," says one emergency medicine leader. Efforts to stem patient flow should be undertaken while recognizing the patient's role in the decision to seek treatment. Internal and external approaches are required.

This article first appeared in the May 2015 issue of HealthLeaders magazine.

In addressing ED flow problems, one can look at the demand side (ED visitors), the supply side (inpatient beds, usually), and the efficiency of what happens within the ED itself. Of course, there are circumstances where approaching the demand side of ED volume makes sense, but efforts to stem patient flow should be undertaken while recognizing the patient's role in the decision to seek treatment, and the patient's self-appraisal of the urgency.

Alex Rosenau, DO, FACEP, CPE, is senior vice chair of the department of emergency medicine for the Lehigh Valley Health Network of Allentown, Pennsylvania, which includes five hospitals, five emergency rooms, 17 community clinics, 12 health centers, and 10 ExpressCARE locations. He notes that it is not known whether a patient is nonemergent until that patient has been seen by physicians or other qualified medical professionals and a disposition has been made. The patient determines the need to be seen, and the ED staff determines the patient's condition and makes decisions about what steps to take to stabilize the patient.


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"If you feel you need to be seen, I'm happy to see you," Rosenau says. "We are the masters of unscheduled care, in the end. And most unscheduled care is a perceived emergency on the part of the patient."

Michael Zeis

Michael Zeis is a research analyst for HealthLeaders Media.

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