Emergency department physicians are now one of the major decision-makers in hospitals, according to a recent RAND Corp. report. More than half of hospital admissions come from the ED, making this department an important factor in hospital revenue and costs. By leveraging the position of EDs as transition centers for patients among home, the hospital and other facilities, hospitals can improve care delivery and lower costs.
Alex Rosenau, DO, senior vice chair of the ED at Allentown, Pa.-based Lehigh Valley Health Network and president-elect of the board of directors for the American College of Emergency Physicians, explains three ways hospitals can optimize the use of their ED.
1. Improve care coordination. The ED's role admitting and discharging patients requires a high level of care coordination. Dr. Rosenau suggests support people such as social workers and psychiatric evaluation professionals staff the ED to help patients transition from the ED to inpatient care, home or another facility. Communication among these professionals, both within and outside the hospital, will be critical to ensuring patients' safety during handoffs between providers.
Dr. Rosenau also suggests the leaders of each hospital department, including the ED, and hospital administrators meet on a regular basis to discuss patient transitions, practice standards and other issues. "Physicians cannot continue to operate in silos. They need to meet together, plan together and [ensure] their guidelines overlap," he says. "That degree of transparency brings more perspectives and knowledge to bear on the problems we're going to face."
2. Increase access. One of the challenges in healthcare today is a shortage of physicians, particularly primary care physicians. In fact, an increase in medical students is being offset by a limited number of residency openings, leaving some medical students out of a job despite a high need for their services, according to Dr. Rosenau.
With expanded coverage under the Patient Protection and Affordable Act, physicians will be in even more demand, which may cause spillover to EDs. "Coverage does not equal access," Dr. Rosenau says. "Most primary care doctors have full panels; if there's no room for appointments with new patients, [patients] by default might choose to go to the ER."
To prevent overcrowding and excessive wait times, hospitals need to build the infrastructure for other sites of care, such as freestanding emergency departments, urgent care clinics and retail clinics, Dr. Rosenau says.
3. Use observation units. An important resource in the ED that can improve patient flow and prevent hospital readmissions is the observation unit. Using these units to answer a specific question about a patient by following protocols can avoid an admission or readmission because observation unit stays are not defined as inpatient stays, according to Dr. Rosenau.
Working with ED physicians and staff to coordinate care, increasing access to alternative sites of care and using observation units appropriately can help hospitals make the best use of their ED.
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