Creating the Blueprint for ED Throughput Improvement

In 2009, Emergency Department (ED) visits went up to 136 million from less than 124 million in 2008 - a 10% increase and the steepest single-year upsurge on record. The number of uninsured patients increased to 19%, compared with 15.4% in 2008.

There is a current struggle to meet the ever-growing demand for emergency services. It is exacting a significant toll on many EDs and hospitals. Substantial emergency room wait times and extensive lengths of stay imperil quality of care and can lead to life threatening outcomes for the most acute patients.

Hospitals that wish to optimize throughput and capacity of their EDs must focus on three key areas:

1. Creating Effective Capacity and Addressing Capacity Constraints
2. Reforming Core ED Processes
3. Accelerating Bed Availability

Creating effective capacity requires a re-examination of all ED processes from the customer’s point of view. The customer is first and foremost the patient, but he or she can be the EMT, attending physician, or family member. Delays in hand-offs and parallel vs. serial processes add significant time to patients visits.

In one 350-bed urban hospital, structuring efforts led to 9.1% increase in visits; 27.3% increase in admissions; 43.5% decrease in incomplete care (LWOBS, AMA, LIMT); and 1 hour and 51 minute reduction in overall length of stay in the first 3 months. This created an effective capacity of an additional 19 beds throughout the day.

While reforming these processes is vital in optimizing throughput, it is often only half of the equation; inpatient bed availability is often a major problem. The first challenge to address is the transitioning of an admitted patient to the inpatient unit. This often involves multiple calls between ED nurses, inpatient nurses and the admitting department. ED staff and administrators spend significant time hunting down beds because inpatient staff are reluctant to take on a new admission. A patient placement command center or “bed czar” can coordinate the competing demands from the ED, OR, ICU, Telemetry and direct admissions.

Finally, hospitals must begin utilizing data and technology to optimize ED throughput. The use of patient tracking systems, demand-matched staffing structures, and performance monitoring through dashboard and ED business intelligence tools can often create enormous value at leading hospitals. With each added ED bed costing $250,000 to $1,000,000, investment in ED throughput is a worthwhile financial investment.