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Simple Changes for Boosting ER Throughput

By jfellows@healthleadersmedia.com  
   September 18, 2015

Improving patient flow through a busy emergency department does not have to be as expensive or as complicated as the cases that come through the door.

This article appears in the May 2015 issue of HealthLeaders magazine.

The effective and efficient triage of patients is key to the flow of an emergency department. Not only for practical reasons but also because a new survey measuring patient satisfaction in the ED is on the horizon. ED-CAHPS—similar to HCAHPS, the survey that allows patients postdischarge to rate hospitals on communication, noise level, and other factors—is in development now.

Providers originally expected the Centers for Medicare & Medicaid Services to begin using ED-CAHPS this year, but delays have pushed it back to 2016. Still, hospitals and health systems that have made patient experience a priority are not holding back on preparing for ED-CAHPS.

But surveys are not the only driver, nor even the main driver, of organizations' repeated attempts to reorganize processes for better throughput. When EDs are crowded with patients who can be treated elsewhere, it prevents patients with acute needs from being seen quickly, which can impact cost and quality.

While frequent fliers to the ED have been a focal point of throughput improvement, some hospitals have complemented those efforts with new strategies. For example, some organizations are designing elder-friendly EDs because such patients represent a significant percentage of ED visits. Hospitals that are building new EDs are using the construction as an opportunity to re-create the space for improved function.


Hany Atallah, MD

Organizations using these approaches are finding that the changes they have to make are relatively simple, inexpensive, and effective. The changes also could have a positive impact on patient satisfaction and experience benchmarks.

Success key No. 1: Change the flow of patients

Grady Health System in Atlanta has one of the busiest EDs in the city, seeing more than 125,000 patients annually. Construction has started for a 15,000-square-foot addition to the ED. That's scheduled to be complete in late 2016, but some bottlenecks need to be improved sooner. For better door-to-provider times and patient experience in the ED, Hany Atallah, MD, chief of emergency medicine for Grady Health System, implemented a new throughput strategy that changed the way patients flow through its ED.

"We're pretty tight on space, given our volume," says Atallah. "We've started focusing on which patients can be treated vertically so they don't need to lie down on a stretcher."

Atallah says his team studied the daily ED patient census and determined that 50% of patients can be treated vertically. Keeping patients off stretchers or beds helps move things along more quickly, he says, and has reduced the length of stay in the ED by three hours for its lowest-acuity patients—the ones who are most likely to be able to sit upright while getting treated.

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Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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