June Spotlight – Emergency Medicine: Improving patient flow through the ED; how YOU can help the process

Submitted by Kelly Henry, director, Performance Improvement and Regulatory Affairs, and Steven Gamburg, MD, Chair, Emergency Medicine

 

Improving Emergency Department (ED) patient flow is a process improvement priority at Main Line Health and is important for the comfort and safety of our patients. Our challenge has been to effectively decrease the time from the decision to admit the patient, to transporting the patient out of the ED to their inpatient bed.

 

By improving our “flow times” we hope to decrease patients “boarding” in the ED. Numerous studies suggest that patients who board in the ED have poorer outcomes and longer inpatient lengths of stay. And avoiding overcrowding in the ED allows newly arriving patients to be seen more quickly and treated faster.

 

Emergency Department overcrowding is a national crisis; volume is increasing at about 3% per year across the country as more patients become insured. And the ED still serves as a safety net for the uninsured and underinsured.

 

Problems with patient flow may manifest in the Emergency Department, but there are many factors outside of the ED that will help improve flow.

 

Below are some practices that attending physicians can utilize in order to directly improve patient flow. Your patients will appreciate your help as we safely expedite their care.

 

1)    When you are the attending physician and are admitting a patient from the ED, please complete your admission orders as soon as possible to help expedite flow. You may also simply write Bridging Orders (essential admission orders needed for safe transport to the floor) and later write full orders.

 

2)    Telemetry and ICU guidelines ensure appropriate placement of your patient. Adhering to them is essential to maintain compliance. And assigning the correct bed on the first try avoids the need to reassign the bed placement and avoids delays in flow.

 

3)    Prepare your inpatients for discharge by notifying the patient, family and case management as early as possible. And try to make arrangements for discharge as early in the day as possible. Our biggest hurdle to admission is no beds being available in the hospital.

 

The ED has initiated a host of items to improve timeliness including a Rapid Evaluation Process, Bedside Registration, Welcome Admission, “Pull til Full,” Huddles, Internal Waiting Rooms, etc. We need your help to continue to improve, and we sincerely appreciate your support.

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