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.