Improving Patient Throughput In Your Emergency Department, Part I

To improve the overall performance of your Emergency Department you must start by breaking up this complex department into individual areas and focusing on each area. As I stated in yesterday's post, I want to look at three areas and give some specific action steps that can be taken in each of these areas. Again these areas are:
-Patient throughput
-Staff Productivity
-Building New Business

Today let's look at Patient Throughput. This is a key area of dissatisfaction among patients and ranks as the number one concern from most ED Patient Satisfaction surveys. Getting patients through faster is easy to talk about but complex to actually achieve. In order for most EDs to achieve this they will have to undo a lot of existing steps and processes that over the years have become ingrained in the culture of that institution. What I am suggesting is drastically changing that culture which can only occur with a comprehensive effort that is constantly measured and kept in place for an extended period of time.

The following Action Steps will help you navigate through this process.
1) Decrease the number of patients who leave without treatment (LWOT). You should already be tracking this number, if not you need to start. High performing EDs have this under 1%. Keep in mind that in addition to those patients who register and leave, there is another group that you never count. These are the patients who come in, see the wait and walk out without registering. Set up a task force to look at this area specifically and provide a mechanism to track and report this on a daily basis for the team.
2)Decrease Door to Discharge time for the "treat and street" patients. All hospitals have a great triage system in place to make sure critical patients are taken care of right away. But what happens to the walkie talkies. High performing hospitals average under 2 hours door to door for these patients. Again, get your task force in place armed with the tools they need to make change and measure their progress.
3) Decrease Door to Admit Time for the critical patients. Most hospitals have the treatment part of this down pat. Where many drop the ball is actually discharging the patient from the ED and transferring them to a unit in the main hospital. Once they are in an acute bed is your real discharge time. High performing hospitals average under 3 hours for this group of patients. This is usually held up for two reasons; there are no acute beds available, or there are too many steps and disincentives for staff to make this timely process. Again its time for an action team.

More on this tomorrow

Mark Brodeur