Having spent many years as an emergency physician, I have seen a lot: terrible tragedies, amazing resilience, passionate, hard-working clinicians, and oftentimes, ways we could have improved our clinical workflows, if we only had the time and technology to do it. Unfortunately, the long waiting times and overcrowding common in many emergency departments (EDs) can lead not only to patient and clinician frustration, but also to delays in clinical care, safety concerns, and additional cost. In fact, given the high cost of care associated with emergency care, improving throughput time remains a prime objective for hospitals and healthcare systems.
The scope of the problem
According to the CDC, there are 130 million ED visits per year in the U.S. Of these, 16.2 million result in hospital admissions. The big question is: How long are these patients waiting for their care? It turns out that 43.3% of ED patients are seen within 15 minutes, leaving more than half with potentially long waits for their clinical problems to be attended to.
The role of enhanced communication
Many regard lengthy ED delays as the tradeoff for the ability to receive care at any hour – day or night. However, in many cases these delays really come down to the efficiency of staff communication. Improving how all staff and clinicians connect, both inside and outside of the ED, can directly improve care and establish a positive experience for patients, physicians, nurses, and support staff alike. Here’s how:
- Ensure open ED beds are filled
Although it sounds intuitive, it’s key to place patients in an ED bed as soon as possible upon their arrival to reduce the amount of time they have to wait to be seen by a clinician and receive some peace of mind. Secure text messaging and phone calls that pull from an accurate online directory support swift, effective exchanges of bed availability between the waiting area and triage staff, as well as between nurses and providers to speed their initial evaluation.
- Improve the timeliness of treatment, even without sufficient bed space
As EDs often operate at or over capacity, staff sometimes have to get creative. When rooms are not available, assessing a patient’s symptoms in an overflow sitting area or even the hallway can speed and facilitate obtaining appropriate labs or X-rays to keep the evaluation process moving. Given that 2.4% of patients leave the ED without being seen, improving wait times can help your organization provide necessary care, recoup lost revenue, and improve patient and staff satisfaction.
- Prepare for disaster scenarios or other unexpected demands for service
Have a plan in place for expanding service on an ad hoc basis in the event of a large influx of patients . This could be part of a business continuity/disaster recovery or mass casualty plan, if it is infrequent at your organization. ED staff would be able to initiate this deployment rapidly with a simple phone call or secure text message that mirrors rapid response workflows and includes all relevant personnel/roles and factors in their on-call schedules automatically.
- Streamline inpatient admission
An Emergency Department Benchmarking Alliance (EDBA) survey looked at two critical metrics for ED patients being admitted to the hospital. They found the median length of time from patient arrival in the ED until the admission decision was 188 minutes. Likewise, there was a median time interval of 116 minutes between an admission decision and the transfer to the inpatient area. Clearly, there is room for improvement on both fronts. Establishing efficient workflows involves ED and inpatient staff who are key to getting patient transfers moving. With the support of secure messaging, you can quickly and easily involve the full care team — including transport staff, bed control, charge nurses, hospitalists, housekeeping, food service, and more — in relevant communications and requests.
- Ensure quick room turnover between patients
Room turnover is a challenge for many hospitals, largely due to breakdowns in communication after a patient vacates an ED bed. Notifying housekeeping or environmental services immediately upon a patient’s discharge or admission to the hospital means more timely cleaning and turnover of patient rooms. A secure messaging system that offers device flexibility means staff who carry pagers can be notified alongside those with smartphones that a patient has been discharged and the room is available for the patient waiting for admission in the ED.
- Give staff visibility to improvement initiatives
Improving ED throughput can feel like a nebulous goal if staff aren’t provided with visibility to important metrics and how they personally can play a role in solving the problem. Sharing measures via smartphone alerts for patient arrival time, ED provider time, notification of clinical test results, LOS, disposition time, and disposition to admit or departure time highlights opportunities for improvement and gets everyone aligned when additional action may be required.
Track the metrics that matter
As with many aspects of healthcare, there are numerous metrics you could measure to determine your baseline and ongoing progress toward better ED throughput. Below are some of the standard metrics many organizations are tracking to hit these targets:
- Arrival-to-provider time
- Arrival-to-departure time (length of stay)
- Discharge time to patient departure time
- Admit decision time to ED departure time/arrival in an inpatient bed
- ED room turnover time by environmental services/housekeeping
- Test result turnaround time
- Patients leaving without being seen (LWBS)
Everyone benefits when the ED runs smoothly
There is an old saying that the ED is the hospital’s front door to the community. As a result, sometimes there is a waterfall effect where ED delays can have an adverse impact on a hospital’s reputation. Hospitals must find ways to improve their patient throughput and operational efficiency. Although solving the complexities of ED throughput will not happen overnight, it is possible to streamline clinical workflows through a dedicated approach to monitoring analytics and process improvement. Making inroads on the key metrics noted above will not only improve patient care, safety, and satisfaction, but also can reduce costs and improve ED staff morale.
An enterprise communication platform like Spok Go® provides a solid foundation for process improvement by enabling all members of the care team to interact securely for admissions, discharges, transfers, critical test results, codes, and much more. In fact, TidalHealth leveraged Spok Go to achieve a 44-minute improvement in ED boarding time and a 31-minute reduction in the overall length of patient stay in their ED in just two months.