Jeff Wood, RN, vice president of hospital-based services at TeamHealth, and Barbara Blevins, COO of hospital-based services for TeamHealth, discuss six best practices for running a successful, cost-efficient and efficient emergency department.
1. Utilize cost-effective strategies. Emergency departments should use cost-effective strategies such as instituting a five-level triage process, a "pull-to-full" strategy, split-flow models, fast tracks, Quick-Pass and Lean. These strategies can have a significant impact on patient flow, according to Mr. Wood. Quick-Pass, also known as hot bedding, is an evidence-based practice designed to get a patient to a provider as quickly as possible. "While some EDs refer to the process as immediate bedding, TeamHealth recommends branding the process of immediate bedding by calling it Quick-Pass. Doing so makes it easier to train, learn and implement. It also signals to the staff that we are 'starting fresh' on this initiative and that we are not simply tweaking an existing, inefficient process," said Mr. Wood. Quick-Pass is for use during non-peak times and any time in which there are open beds. This practice improves patient flow, decreases physician-to-physician handoff time and improves the patient's experience and satisfaction.
2. Practice effective communication. According to Mr. Wood, communication is important for a successful ED. "Clear communication between emergency physicians at change of shift and during post discharge phone calls are another effective tool to manage patient risk as they provide an opportunity to ensure that the patient is compliant with discharge instructions," said Mr. Wood.
3. Implement a strong risk management program. A strong risk management program is also essential for the fast-paced and efficient emergency medicine environment. A program grounded in evidence-based medicine can even reduce unnecessary ancillary costs and also reduce the physician's — and thus the hospital's — risk of a malpractice suit. "As the front door to the hospital, a top-performing emergency department improves the hospital's image within its community, resulting in an increase in the hospital's overall market share and downstream revenue," said Mr. Wood.
4. Ensure strong leadership. Strong leadership is essential for any organization that desires to effect change, and the ED is no different. The medical director sets the tone for the entire department and for this reason, directly impacts staff morale, medical staff involvement, patient satisfaction, core measure compliance, patient throughput and finances. "Unfortunately, leadership skills are not regularly taught in medical school, and many physicians are promoted to a medical director position without the necessary leadership experience or training to be effective. To be successful in this role, a medical director needs formal and ongoing leadership development training and extensive support from physician colleagues and administrative leaders," said Mr. Wood.
In addition, Ms. Blevins recommends that an ED has the right physician and nursing leadership in place. "The No. 1 success indicator in high functioning EDs is having a highly effective physician medical director and a highly effective nursing director. That's the most important thing hospitals can do to make sure they're hiring and retaining the right people," said Ms. Blevins.
5. Offer physician professional development. Developing and training physicians is important for the long-term success of the ED and for physician retention. "One of the things we do at TeamHealth to help improve physician retention is work with the healthcare improvement firm Studer Group. They've done years of research to determine the tactics that improve retention. For example, we do monthly rounding on all of our facility medical directors, and we do monthly rounding on all providers to make sure they're demonstrating good care, to discover opportunities for improvement that the provider has identified in the ED and to see if there are people that providers want to recognize for doing extraordinary work," said Mr. Wood.
6. Foster good relationships with emergency medical services. Another sometimes-overlooked factor is the ED's relationship with emergency medical services. EMS professionals often choose the hospital to which they deliver their patients. "If the paramedics are positive about your ED and they'd feel comfortable taking a loved one to your ED, then they'll bring more volume to you. And, these patients are typically higher acuity patients who need an inpatient admission," said Mr. Wood. If you have a poor relationship with EMS, you could be risking that potential for additional volume and revenue.
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1. Utilize cost-effective strategies. Emergency departments should use cost-effective strategies such as instituting a five-level triage process, a "pull-to-full" strategy, split-flow models, fast tracks, Quick-Pass and Lean. These strategies can have a significant impact on patient flow, according to Mr. Wood. Quick-Pass, also known as hot bedding, is an evidence-based practice designed to get a patient to a provider as quickly as possible. "While some EDs refer to the process as immediate bedding, TeamHealth recommends branding the process of immediate bedding by calling it Quick-Pass. Doing so makes it easier to train, learn and implement. It also signals to the staff that we are 'starting fresh' on this initiative and that we are not simply tweaking an existing, inefficient process," said Mr. Wood. Quick-Pass is for use during non-peak times and any time in which there are open beds. This practice improves patient flow, decreases physician-to-physician handoff time and improves the patient's experience and satisfaction.
2. Practice effective communication. According to Mr. Wood, communication is important for a successful ED. "Clear communication between emergency physicians at change of shift and during post discharge phone calls are another effective tool to manage patient risk as they provide an opportunity to ensure that the patient is compliant with discharge instructions," said Mr. Wood.
3. Implement a strong risk management program. A strong risk management program is also essential for the fast-paced and efficient emergency medicine environment. A program grounded in evidence-based medicine can even reduce unnecessary ancillary costs and also reduce the physician's — and thus the hospital's — risk of a malpractice suit. "As the front door to the hospital, a top-performing emergency department improves the hospital's image within its community, resulting in an increase in the hospital's overall market share and downstream revenue," said Mr. Wood.
4. Ensure strong leadership. Strong leadership is essential for any organization that desires to effect change, and the ED is no different. The medical director sets the tone for the entire department and for this reason, directly impacts staff morale, medical staff involvement, patient satisfaction, core measure compliance, patient throughput and finances. "Unfortunately, leadership skills are not regularly taught in medical school, and many physicians are promoted to a medical director position without the necessary leadership experience or training to be effective. To be successful in this role, a medical director needs formal and ongoing leadership development training and extensive support from physician colleagues and administrative leaders," said Mr. Wood.
In addition, Ms. Blevins recommends that an ED has the right physician and nursing leadership in place. "The No. 1 success indicator in high functioning EDs is having a highly effective physician medical director and a highly effective nursing director. That's the most important thing hospitals can do to make sure they're hiring and retaining the right people," said Ms. Blevins.
5. Offer physician professional development. Developing and training physicians is important for the long-term success of the ED and for physician retention. "One of the things we do at TeamHealth to help improve physician retention is work with the healthcare improvement firm Studer Group. They've done years of research to determine the tactics that improve retention. For example, we do monthly rounding on all of our facility medical directors, and we do monthly rounding on all providers to make sure they're demonstrating good care, to discover opportunities for improvement that the provider has identified in the ED and to see if there are people that providers want to recognize for doing extraordinary work," said Mr. Wood.
6. Foster good relationships with emergency medical services. Another sometimes-overlooked factor is the ED's relationship with emergency medical services. EMS professionals often choose the hospital to which they deliver their patients. "If the paramedics are positive about your ED and they'd feel comfortable taking a loved one to your ED, then they'll bring more volume to you. And, these patients are typically higher acuity patients who need an inpatient admission," said Mr. Wood. If you have a poor relationship with EMS, you could be risking that potential for additional volume and revenue.
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