Universally, the appropriate utilization and optimization of Emergency Departments (EDs) is a complex challenge.
The unpredictable nature of the ED and the chaotic, high-stress environment make best-practice improvements difficult to pinpoint or standardize. The lack of sufficient medical homes is contributing to patient volume increasing as more people are continuing to use the ED as the first place to go for care. Increasingly, the ED has become the "front door" of the hospital and the 24/7-entry point for both the insured and uninsured with every ailment ranging from a life-threatening car accident or heart attack to gastroenteritis or a broken ankle.
The Business of Running an ED
When every second counts, improving ED efficiency is critical. Every hospital is focused on increasing throughput capacity to treat as many patients as they can as quickly and effectively as possible. This is important not just from a patient outcome perspective but a hospital reimbursement and revenue standpoint as well. Many EDs are based on a model that reimburses on metrics such as length of stay (LOS) and wait times for patients so they are incentivized to get patients in and out of the emergency department while meeting standardized national quality measures.
Beyond the key goal of performance optimization, some hospitals are extending the strategy of the ED to address larger value-based population health issues and strive to treat the patient in the most appropriate care setting from a cost standpoint. The goal of these hospitals, ultimately, is to keep patients out of the ED from the beginning and have them go to a point-of-care setting that is more appropriate with their clinical situation such as a physician's office or an urgent care center. This approach requires a shift in focus from volume to value and must address nuances in particular population health issues. Healthcare executives must consider how they can appropriately shift patients with minor issues such as a fever or limited injuries to a more appropriate setting effectively.
For the c-suite, this means thinking more strategically about the motivation of their particular ED and how it affects the larger hospital/health care system. The answers to these questions require a thorough market and demographic analysis, insight and clinical expertise that are often found with the help of strategic partners to make data-driven decisions. Regardless if the hospital or system focus is volume-based or value-based, healthcare executives are dealing with similar issues around appropriate utilization of ED resources and determining what works best for their particular hospital, patient population, or region.
Urgent Need for Data-driven Decisions
To improve ED performance metrics, hospital executives need to have access to meaningful performance data within the ED and other strategic departments and ensure the validity of the data to affect meaningful change. Using robust data analytics, hospital leaders can work with strategic partners to create a data-driven assessment and near real-time metrics dashboard to provide high-level and detailed information on key performance metrics as well as identify areas that are performing well or require intervention. Data-driven decisions are essential to ED optimization and improving the key regulatory performance metrics by which EDs are assessed.
Case in Point: Improve Metrics, Increase Revenue1
A 460-bed community hospital with a history of unsustainable success in process improvement was not meeting its ED expected performance and wait time targets. The 48,000-annual-visits ED had previously tried to address the issues by developing a fast track program, followed by a model where a mid-level provider would initiate workups on select low acuity patients. Neither initiative took hold nor had the impact on flow that the organization sought.
Working with a strategic partner, the hospital was able to better assess issues and collect relevant data to identify two major areas of opportunity: revising front-end processes and re-aligning staff resources away from a serial model of care. Based on this critical data, the hospital was able to make key changes to patient care and flow. As a result, the department realized significant improvement in arrival-to-triage (68%) and arrival-to-room (77%) metrics as compared to its baseline. Additionally, there was a 51% decrease in the number of patients who left the ED without treatment. The decrease in ED walk-a-ways generated additional collectable revenue of over $2 million annually for the organization.
The ED of the Future
The emergency department of the future must be optimized from both the business side and the patient side and viewed not only within the ED but also as it compares or competes with other EDs outside of the hospital. To truly optimize performance, hospital executives must delve deeper into areas of discovery on utilization patterns, acuity patterns, and population trends over time. While patient volume may appear unpredictable in the short-term, if it is analyzed over time, volume patterns can be more easily anticipated for the future.
Looked at in this way, it's clear that more insight can be revealed to further ED optimization. Many hospitals are enlisting strategic partners to help address these complex challenges, train on best practice recommendations, and support the implementation to sustain meaningful change. As the ED becomes the new "face" of the hospital and strategic community partners, its overall success, optimization and importance in delivering care cannot be overlooked. With long-term sustainable transformation of the ED, healthcare organizations can regain potentially lost revenue while elevating the level of care and increasing patient satisfaction.
About the authors
Mark Feinberg
Managing Partner, Philips Blue Jay Consulting
Mark has more than 25 years of experience in healthcare, leading client engagements focused on operational effectiveness, patient throughput, supply chain optimization, pharmacy improvement, case management, interim ED management, and perioperative services. He brings a critical eye and significant management expertise to each project. He co-founded Blue Jay Consulting in 2006 which was acquired by Philips in 2015. Trained as an emergency medical ambulance technician, Mark holds a master's degree in business.
Suzanne Stone-Griffith, MSN, RN, CNAA
Principal, Philips Blue Jay Consulting
Suzanne brings a wealth of healthcare experience, with expertise in metrics and performance improvement. She led the development of the largest automated and integrated ED database for HCA and created the HCA ED Playbook which served as a process improvement roadmap for every ED in the country. She holds an MSN and a BSN, as well as being Lean Certified, a master trainer for Team STEPPS and chairman/co-chair of three prestigious healthcare panels.
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