This white paper from the New York State Department of Health describes operational differences between freestanding emergency department and urgent care centers and gives pros and cons compared with hospital-based emergency departments.
The PRO Publica website shows current and average wait and service times for most hospitals in the U.S. and roll-ups by state. How does your hospital stack up?
Starting in 2012, Washington emergency rooms began tracking patients in a mandatory, statewide database as part of an effort to supply the necessary health information to divert patients from trips to emergency rooms for non-urgent problems. Dr. Nathan Schlicher, an ER doctor who serves on the board of the Washington State Medical Association, said the Emergency Department Information Exchange has given hospitals a way to monitor patients and keep hospitals up-to-date regarding patients' health records.
The Daily Rx summarizes on a study led by Dr. Jeremiah D. Schuur, an emergency medicine specialist at Brigham and Women's Hospital in Boston, to reduce excess utilization and costs in the Emergency Department.
This is a summary presentation of one year results from a project at Mayo Clinic in Florida aimed at improving the operational performance of a hospital's operating rooms by assessing and managing variability. The changes resulted in a 5 per cent increase in OR utilization and net revenue and a 27 percent reduction in overtime. These data were also published in the June 2013 Journal of The American College of Surgeons.
This article promotes using scribes as a cost-effective alternative to adding physician, nurse practitioners or physician assistant staffing in the emergency department.
A presentation at the 2013 SHS Healthcare Systems Process Improvement Conference
Hospitals and health systems spend millions of dollars to acquire and meaningfully use certified EMRS and EHRS nationwide. This presentation from HSPIC 2013 describes a for-profit health system's experience in deploying efficient workflows that lead to increased acceptance and usage by physicians and other stakeholders to realize many benefits including receiving CMS incentives.
One hospital was able to reduce patient charges by over $300,000 annually by reducing the frequency of amylase and lipase testing for ED patients with abdominal pain and other conditions.
Dr. Stephen Feagins, vice president of medical affairs, describes how ER wait times were reduced by 70 percent at Mercy Health's Anderson Hospital in an interview with the Cincinnati Business Courier.
Dr. Crane addresses a host of issues in this article for improving ED performance including the application of queuing theory, demand matching, and more frequent budgeting.
Much attention is given to RN and other support staffing in the Emergency Department while neglecting to look at ED provider staffing. This article in ACEP News gives some recommendations for provider staffing that may be the most important driver of patient throughput in your ED.
The authors of this presentation describe how industrial engineering research improved patient access and reduced cost by applying a machine learning simulation approach at Grady Health System in Atlanta.
This article in the Harvard Business Review describes how one emergency department went from the sixth to the 99th percentile in patient satisfaction using a lean framework to eliminate waste.
This article promotes using scribes as a cost-effective alternative to adding physician, nurse practitioners, or physician assistant staffing in the emergency department.
Long waits in the waiting room, patients leaving without being seen, patients boarding and holding in the ED, delayed test results, and diversions. Have you encountered these issues in your ED? This presentation from a prior SHS Conference highlights improvements through several ED projects at HCA and will provide you with a sample of the tools utilized, results, best practices, and lessons learned.
This paper, presented at a previous Society for Health Systems Conference, provides a detailed approach to determining emergency department staffing needs.
An improvement team at Advocate Trinity Hospital in Chicago addressed the issue of a high rate of "left without being seen." This presentation at the Healthcare Systems Improvement Conference 2012 describes how an improvement team used information systems and analytical approaches to gather information on the root causes for problems and potential solutions in the ED. Leadership rounding throughout the ED, establishing effective treatment protocols and finally, front loading medical orders to help expedite patient treatment and prompt patient disposition. After implementation of the above planned measures, the LWOT percentage reduced from the highest rate of 12.4 percent in July 2009 to 1.1 percent in June 2011.
Surviving the global healthcare perfect storm
The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article
Evolution of the ED
This recent article from the American Institute of Architects describes progressive improvements to ED design from the author's perspective. Examples of this evolution are provided from University Hospital in Cincinnati, Strong Memorial Hospital, Marymount Hospital, and University of Pittsburgh Mercy Hospital.
This paper, published by the Society for Academic Emergency Medicine, compares seasonally adjusted and sinusoidal models against historical hourly averages for four- and 12-hour advance census forecasts. The authors conclude that the two more advanced methods are more robust than historical averages.
This study from the Academic Emergency Medicine organization of more than 25,000 admissions at five different hospitals found that that there is a moderately strong correlation between ED length of stay and inpatient census of ICU and telemetry units. This study infers that reducing inpatient occupancy rates may be an effective way to reduce ED length of stay.
Hospitals would save more money by reducing avoidable patient admissions from the ED than by preventing non-urgent ED visits, according to a study (abstract only) in the Annals of Emergency Medicine. Researchers found that the cost of expanding urgent care centers or extending primary care hours would offset these savings of reducing minor injury and illness visits to the ED. However, substantial benefits could be realized by investing in systems that reduce ED admissions through comprehensive patient-centered care.
This YouTube video shows some details of how Penn State University at Hershey implemented a no-wait ED with physician directed queuing (PDQ). The changes allow the ED to treat 50,000 patient annually in an area designed for 30,000 visits.
The Agency for Healthcare Research and Quality recently released this publication providing many practical approaches to reducing emergency room overcrowding.
A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.
Sunnybrook Health Sciences Centre is considering implementing recommendations made by three fourth-year students at the University of Windsor Industrial and Manufacturing Systems Engineering as part of their capstone project. Ben de Mendonca, Josh Vandermeer and Andrew Phibbs, conducted an intensive examination of the system used by the emergency department to collect and label patient blood samples.
A recent study in the Annals of Surgery found that high quality hospitals deliver lower cost care to trauma patients, according to a news release by the University of Rochester Medical Center.
In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.
In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow.
Industrial engineering principles are applied in improving patient flow at Odessa's Medical Center Hospital in Texas.
Emergency department operations: The basis for developing a simulation tool
In this paper originally published in IIE Transactions, the authors describe a foundational approach for simulation modeling of emergency departments that is general, simple, intuitive and easy to use.
The results of a Canadian study published last year in ACEP News (American College of Emergency Physicians).
A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.
An ED is redesigned after patient flows were modelled using queuing theory.
The process of creating and achieving approval of an ED simulation is discussed.
Improvement projects in surgery, nursing, and the ED are discussed. The process of moving a hospital towards adoption of Lean Six Sigma is also described.
An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.
The surgical admitting process is targeted with a lean event. Current and future state is described, the process of improvement is shown, and results are discussed.
Three successful lean projects are discussed in detail. The ED, Radiology, and HR departments all show significant improvement.
A lean event focused on patient flow out of the ED was conducted, and results are discussed
All processes in an ED are redesigned, with multiple outcomes showing improvement.
A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases. Simulation shows further viability of new processes. This presentation is made by a MD who became a lean coach.
This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.
ED throughput process improvement projects are discussed. The presenter is a MD. Several changes are shown with great results.
Multiple projects are performed to improve an ED. Problems are stated and results are given.
The author facilitates a lean educational journey through an ED.
A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.
Emergent Care was redesigned to decrease wait time significantly.
ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.