ED Crowding and Patient Flow

ED crowding has become a challenge for hospital leaders around the world. It reflects an imbalance between the clinical workload of staff and the resources available to carry out that work. Excessive ED crowding increases risks of error and adverse events for patients which may lead to higher morbidity and mortality rates, as well as lowered patient and staff satisfaction. Many factors can contribute to creating ED crowding, including patient factors (inflow), ED factors (workflow processes) and hospital factors (outflow). Current research on ED operations and flow reveals that ED crowding is multi-factorial in nature and that the most successful solutions are those that approach the issue as a hospital-wide problem, not just an ED problem.  Our faculty work at both community and large academic hospitals and have solved crowding problems in both types of settings.  We will provide you with a comprehensive ED crowding analysis and will help you:

  • Assess your current crowding situation;
  • Understand the tools with which to measure flow;
  • Provide methods to decrease your crowding and improve your patient and staff satisfaction;
  • Effectively communicate your plan for ED crowding reduction to hospital decision makers.
Lean Process

Lean management, typically associated with Japanese manufacturing and the Toyota Production System, is a proven process improvement and management strategy that focuses on cutting costs by improving efficiency, eliminating waste, and streamlining and standardizing processes.  With the advent of healthcare reform, and especially with the development of Accountable Care Organizations, having efficient processes and driving out waste is imperative. The application of lean management principles, or ‘lean thinking,’ in the healthcare industry positively impacts productivity, cost, quality, timely delivery of services and, consequently, overall patient care.

Our project team will work first with your management team and then with your entire ED staff to:

  • Assess your current ED processes to determine which are value-add vs. non value add;
  • Redesign processes to improve flow, reduce waste, and improve patient care and patient satisfaction;
  • Institute a system of continuous reassessment in order to maintain your “lean ED.”
Staffing Strategies

Effectively staffing your ED can be a very difficult proposition. Varying levels of patient volume and differences in average length of stay can create a nightmare for many ED leaders when it comes to staffing programs. Implementing the right staffing model for your ED can lead to satisfied patients, improved patient throughput, and contented clinicians who suffer less from fatigue and burnout.

Our team can help you implement best practices in all areas of ED staffing and help you to:

  • Evaluate staffing needs both at the nurse and physician levels;
  • Implement a dynamic staffing plan that takes into account volume by hour.

One example of our staffing work is found in our valued client, Milton Hospital. In the 5 months since we began managing and operating the Milton ED, we cut the “left without being seen” rate in half (to below 1%), increased patient satisfaction to the 99th percentile (measured by Press-Ganey), and decreased patient turnaround times; all of this while growing ED patient volume by over 15%. See our Milton Hospital Case Study

Observation Units

There is clear evidence that observation units, or places where those patients not clearly ready for either admission or discharge can be cared for, have the potential of reducing cost while also increasing patient comfort levels. Typically, observation units are used to treat patients with chest pain, asthma and heart failure but have also been used for other diagnoses including abdominal pain and transient ischemic attack.  Our faculty have industry leading expertise in the creation and implementation of observation units and will help you:

  • Develop an observation unit as part of the emergency department;
  • Understand the staffing considerations associated with observation units;
  • Develop needed observation unit protocols;
  • Implement virtual observation units.
Quality Assurance / Quality Improvement

Defining and measuring the quality of care delivered by the Emergency Department is essential both for demonstrating to external stakeholders the value of the provided service and for identifying areas in which emergency care delivery can be improved.  Our team will help you:

  • Design a framework for describing healthcare quality: structure, process, outcome;
  • Set standards based on evidence-based guidelines;
  • Define characteristics of indicators;
  • Select an appropriate array of indicators;
  • Implement strategies for measurement and how to get started.
Risk Management

Strategies for managing risks associated with medical legal liability are a key component of overall efforts to improve quality and patient safety. Risk management begins with ‘proactive’ strategies for identifying and mitigating the high-risk aspects of emergency medicine practice, but also encompasses ‘reactive’ strategies for responding to adverse events or errors that inevitably can happen even in the best prepared emergency departments.  Our project team will help you:

  • Understand the important principles of risk management for reducing legal liability;
  • Identify high risk areas in your emergency department;
  • Learn to use evidence-based practices to mitigate risk;
  • Develop plans for responding to incidents with potential medical legal liability.