In the Becker's Hospital Review 5th Annual Meeting in Chicago, Mark Hamm, CEO of EmCare Hospital Medicine and Corbi Milligan, MD, EmCare Hospitalist Site Medical Director for Smyrna, Tenn.-based TriStar StoneCrest Medical Center discussed the challenges standing in the way of an efficient admissions process and ways to overcome those.
The current admissions process is broken, said Mr. Hamm, and it leads to a number of problems including:
1. Financial impact. Reducing patient boarding in the ED can result in significant cost savings for a healthcare organization. According to Mr. Hamm, a recent study found that a one hour reduction in ED boarding time would result in around $9,000 additional revenue per case.
2. Patient satisfaction. Longer ED boarding times leads to frustrated patients, which will result in lower patient satisfaction scores. "The longer the patient stay in the ED, the more likely it is that a hospital will be sued," said Mr. Hamm.
3. Quality perspective. The sooner the patient is admitted and brought to the inpatient floor, the better the patient outcome will be, said Mr. Hamm. In the U.S., the average time for the patient to get from the ED to the inpatient floor is three and a half hours, which can have a adverse impact on patient care.
According to Dr. Hamm, one of the major challenges of efficient patient flow from the emergency department to the inpatient floor is the friction between ED physicians and hospital medicine physicians. These groups are incentivized differently — with ED physicians' work being measured in minutes and hospital medicine physicians' work being measured in days. "These two different cultures conflict with each other," he said.
"At TriStar StoneCrest Medical Center, we implemented a technology called Rap&Go, which has made the communication between hospital medicine physicians and ED physicians a lot clearer and quicker," said Dr. Milligan.
The biggest barrier in communication between the two groups of physicians seemed to be the number of steps involved in contacting each other and relaying information. The technology, which is built into the facility's electronic medical record, allows ED physicians to input the symptoms of a patient and then sends a voice or text message to the hospital medicine physician. "This way the hospital medicine physician knows why he is being contacted and what the situation in the ED is," said Dr. Milligan.
After the technology installation in 2012, the ED volume at TriStar has increased by 15 percent and ED boarding time has decreased by two and half hours. "It improves both patient flow as well as patient perception," Dr. Milligan said.