Emergency Department Efficiency
Healthcare leaders are recognizing the need for efficiency in supporting nonemergent care in the emergency room.
This article first appeared in the May 2016 issue of HealthLeaders magazine.
Emergency departments are optimized to provide emergency care, of course. The timing of medical emergencies cannot be predicted, so EDs must be ready to provide care always. The open-door policy brings patients who need emergency care, patients who worry that they might need emergency care, and patients who don't need emergency care at all. This third category is resilient—a fact of ED life. So, even though ED operations are designed for emergency care, they also must optimize the activities that support patients who do not need emergency care. While the effective handling of patients with emergent conditions remains a principal focus, to deliver that care, EDs need techniques to be effective with nonemergent patients, as well.
Optimize the whole flow
Transferring patients to inpatient floors is identified as a top bottleneck for in-ED flow by 70%, the item mentioned most frequently. Although EDs have a variety of tactics for accommodating patients pending their move to an inpatient bed, the presence of such bottlenecks is inevitable, and their resolution often requires active participation by other hospital departments.
Of course, there are cases where additional ED capacity or additional inpatient beds are required, but more often, capacity is not the issue, says Trisha Cassidy, chief strategy officer for AMITA Health, whose facilities include four hospitals, a center for behavioral health, and seven immediate care centers in the northwest suburbs of Chicago.
"My hunch is that in most of the country there's not a shortage of inpatient beds. There may be a flow issue of when discharges happen, or when ED admissions happen, but I think that's probably a utilization issue as opposed to a capacity issue."