Wednesday, February 10, 2010

Improving Patient Throughput In Your Emergency Department, Part II

Yesterday I began presenting action steps that you can take in your ED to improve patient throughput. Today I would like to finish that list. Certainly this list is not intended to be exhaustive of all the areas you can address, but it does provide key indicators that can make a significant difference in your overall ED function.

4) Decrease Door to Balloon Inflation Time for Acute MI patients needing angioplasty. Although this is a very specific measure, it is one of the most important indicators used to assess the quality of your hospital's cardiac program. It is one of the Core Measures that CMS tracks and publishes on their website. High performing hospitals are now performing this within 60 minutes. I have found that this is a needlessly complex process for many hospitals and the time is increased due to the many approvals needed before the cath lab team is actually activated. A multidisciplinary task force can be very effective to change this.
5) Increase the number of inpatient discharges before Noon. High performing hospitals have 50% of their discharges out by Noon. You may ask what this has to do with ED throughput. The answer for most hospitals is; everything. We used to do consulting engagements for ED throughput just focusing on the ED itself. We quickly learned that ED throughput is directly tied to inpatient throughput as well. Often the ED is backed up with patients who need to be admitted. Often these patients are waiting on a bed to free up on the unit. So getting those inpatients who can go home out of the hospital earlier is key. This may require not allowing patients to take up a bed all day waiting on a ride home. Find an alternative for them. It may also require getting discharges set up for the next day by those late rounding physicians, since you will not get them to change their rounding schedule to accommodate you.
6) Decrease Inpatient Length of Stay. This is related to the previous point and again addresses the issue of freeing up inpatient beds so they are available for ED admits. Most hospitals have thoroughly addressed this issue and feel good about their LOS. Our experience is that by applying the same comprehensive task force methodology, there are always additional opportunities in this area. We usually see at least an additional 15% decrease in overall LOS by addressing this.

This completes my list of the action steps to address ED patient throughput. In upcoming posts I will discuss staff productivity and building new business.

More on this later.

Mark Brodeur

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