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5 Strategies for How Emergency Departments Can Do More with Less

By Jeff Slepin  
   November 02, 2017

Rural hospitals face unique challenges to delivering high-quality care while trying to adjust to the new value-based care models. Yet, providers are demonstrating it’s possible to turn rural EDs into profitable sources of trusted emergency care. Learn five proven strategies for how EDs can do more with less.

Hospitals and healthcare systems across the nation are beginning to adjust to value-based care models while still seeking operational and clinical efficiencies that reduce costs and improve care. Rural facilities, many of which are already operating on tight budgets and with fewer resources, are trying to adjust to the new value-based model as well. They are also encumbered by several major challenges to delivering high-quality care that are unique to their size and location, including geographic isolation, recruiting qualified providers for primary and specialty care, unfavorable payer mix and lack of up-to-date equipment.

In addition, rural hospitals have the responsibility of caring for patients who are more susceptible to certain health risks. Approximately 15 percent of the U.S. population lives in rural areas and, according to a 2017 Centers for Disease Control and Prevention (CDC) study, rural residents were more likely than metropolitan residents to die from the five leading causes of death – heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke. In 2014, rural communities saw about 23 percent more preventable deaths from chronic lower respiratory disease and 18 percent more preventable deaths from unintentional injuries like opioid overdose than metropolitan communities.

Despite the many challenges of rural healthcare, providers are demonstrating that with the help of experienced leadership it’s possible to turn underperforming hospitals and, in particular, rural emergency departments (EDs), into profitable sources of trusted emergency care. Envision Physician Services clinicians practice in 167 rural and community hospital EDs across the nation, implementing innovative strategies that help manage hospital operations, solve for staffing concerns, reduce costs and improve the quality of care.

Drawing from more than 40 years of experience, our leadership team has identified five proven strategies that enable rural EDs and hospitals to provide high-quality emergency and inpatient care.

  • Promote an emergency medicine mindset – Often called on to treat patients with limited information available and time as a constraint, physicians trained in emergency medicine think of the worst possible scenario first instead of the most likely diagnosis. The majority of nonmetropolitan facilities, however, rely on physicians trained in family practice or internal medicine to run their EDs because of recruiting realities. Despite their extensive medical training, it requires time, discipline and retooling for non-emergency trained doctors to think like their colleagues trained in emergency medicine. Hospital leaders can nurture physicians’ ED care approach by helping them learn the right differentials and most useful tests to optimize their emergency diagnostic skills.

  • Map out staffing to optimize ED flow – Looking at acuity and volume, medical directors can map out staffing models that enable physicians and medical staff to manage shifts effectively and work together optimally. Staffing models can also help determine if there is a need to recruit an additional physician, bring in an advanced practice provider (APP) or hire a scribe. In recent years, we’ve seen EDs use scribes to manage patients’ medical records to help relieve physicians of the administrative task and enable them to be more engaged in patient visits.

  • Use telemedicine to your advantage – In rural EDs, there are times when an emergency-trained physician is not on site, there are too few physicians to guarantee timely care or the patient requires care from a specialist. With telemedicine, attending mid-level providers, who may be supplementing clinician hours to support patient volumes, can consult the appropriate physician and receive real-time assistance caring for the patient. The immediate support helps improve patient care and minimize patient transfers, which are often an inconvenience and an added expense for families as well as a lost revenue opportunity for the hospital.

  • Foster a culture of learning and safety – Real-time feedback plays a critical role in an ED’s quality improvement process. Data collection tools provide physicians with real-time performance measurement and analytics to track their progress, which is especially important in hospitals with slim operating margins. The opportunity to address patients’ concerns promptly enhances patient satisfaction and reduces the risk of complications.

  • Encourage patient-centered care – All facilities, especially those in rural settings, can benefit from a culture that promotes patient engagement and education, enforces adherence to best practices and leverages the skills of APPs. When clinicians devote extra time to caring for patients, teaching them safe pain management practices, connecting them with the appropriate resources and encouraging the adoption of a healthy lifestyle, patients become more actively involved in their care and invested in their health. This can lead to fewer ED readmissions and potentially lower patients’ risk of death from preventable causes.

For the most part, the same strategies and techniques that improve emergency care and efficiency in larger hospitals are applicable in smaller and more rural hospitals. With proper staffing, training, motivation and support, a care team in a rural or small community ED setting can achieve the same results as its more metropolitan peers. Contact us today to learn more.

Senior Vice President, Envision Physician Services

and Harry “Tripp” Wingate, MD, FACEP
Regional Medical Director, Envision Physician Services


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