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Simple Changes for Boosting ER Throughput

   September 18, 2015

Even before Grady Health System began using the vertical vs. horizontal determination in early 2014, it had developed other approaches to improve its ED metrics. Atallah says ED staff frequently would provide updates to patients in the waiting room on how much longer it would be until they could be seen.

"Two big things that really impact patient experience in the ED are door-to-provider times and keeping the patient informed," he says. "We would say [to the patients waiting], 'We are working as fast as we can, and we are currently seeing people who have arrived at—' and we would give a specific time."

The hourly communication and addition of dry-erase boards helped some, but Atallah says patient experience in the ED improved more when advanced practice providers were added to the ED staff.

"We went from 13 advanced practice providers to 21," he says. "More patients can be treated vertically, so we need to have enough people to treat them. Faculty, residents, and leadership made sure they were integrated into the practice of care. They help move people along and catch people who can slip through the cracks."

A frequent complaint from ED staff is about the patients who come in for minor illnesses that can be treated at a doctor's office. The walk-in clinics and urgent care centers that increasingly are popping up do absorb some of that traffic. Grady Health System built a walk-in clinic in 2011 that is on the same campus as its main hospital.

"They're peeling off about 80 visits a day for low-acuity patients," Atallah says. "We also have a process where we medically screen every patient by an attending doctor who can explain that a patient will get faster care at our walk-in clinic."

Grady Health System's walk-in clinic, which is open Monday through Friday from 8 a.m. to 8 p.m., has helped to ease the low-acuity ED traffic, but its effectiveness has plateaued because the hours of operation do not coincide with busy overnight and weekend traffic in the ED; plus, overall ED volume at Grady Health System has increased.

Atallah attributes some of the ED volume growth to the economy and the performance of the organization's stroke center.

"We have 24/7 cardiac catheterization capability, and we've seen a huge growth in treating stroke patients," he says. "We've also seen the volume of mental health patients go from 200 per month in 2010 to 800 a month today."

Despite the challenges that Grady Health System's ED is facing, Atallah says there are positive signs that simple changes can work. A patient's door-to-provider time has improved. In 2013, before the changes to patient flow, patients were waiting an average of 133 minutes to see a provider. Atallah says the ED finished 2014 at 105 minutes, and in January of this year, it was down to 98 minutes.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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