At the top of the list of techniques for managing ED throughput are fast track or split flow for low-acuity patients (67%), streamlined registration for arriving patients (57%), and direct or immediate bedding (51%).
Daniel Nadworny, RN, MSN, clinical director of operations for ED and urgent care at Beth Israel Deaconess Medical Center in Boston, with 672 licensed beds and approximately 1,250 full-time and part-time physicians, sees these high levels of response as indications of widespread attention to the whole ED patient flow, instead of intense focus on freeing ED beds via transfer to inpatient floors or discharge from the ED.
He says, "For so long, it was just 'Get them out, get them out.' Now, we're looking at how we have opportunities to improve from start to finish. The focus for a long time had been on disposition. But now we're being thoughtful of the whole process."
Addressing avoidable ED visits
More than half of respondents (59%) include coordinating with primary care providers among their tactics for minimizing avoidable visits to their EDs, the item mentioned most frequently. While a common tactic is for care coordinators or other ED staff to help find a provider for those without a primary care physician, Nadworny notes that a primary care provider/patient relationship may not be enough. Lack of availability of the primary care physician is behind some avoidable visits.
"Quite often I see that a patient has called the primary care physician, but appointments are not available, so the patient is referred to the emergency room. If your first decision point is that the patient doesn't need the emergency room, but then the reason for sending the patient to the emergency room is there isn't an available primary care appointment, then that's a missed opportunity."
More than half (53%) rank primary care physicians first in effectiveness in helping patients make more appropriate use of EDs. But the effect primary care providers may have on helping patients make appropriate use of the ED may be diminished, as mentioned earlier, by the lack of primary care availability and by recommendations to visit the ED that are sometimes offered when a timely appointment is not possible.
Michael Zeis is a research analyst for HealthLeaders Media.