Seven Best Practices to Improve Patient Outcomes in the Emergency Department
November 17, 2017
As the healthcare industry evolves, leaders continue to search for new and more effective ways to meet the growing demands and expectations of patients, payors, and regulators. In no place is this more true than in a hospital’s emergency department (ED) where leaders face mounting pressure to improve metrics and achieve better outcomes in a fast-paced, hectic environment, often with fewer resources.
7 Principles to Improve Patient Outcomes in the ED
While there is no simple answer or one-size-fits-all solution for improving ED operations and flow, here are some proven principles to consider to enhance efficiency and reduce overall turnaround times:
- Examine the ED and all of the steps in the flow process with a fresh set of eyes. Look at all of the steps in the process and determine whether or not each of them is necessary.
- Remove (or reduce) any wasteful or unnecessary steps in the process.
- Create a process that encourages individuals to do things in parallel (versus serial). For example, in some EDs, the RN and MD assess the patient together in a joint process.
- Ensure that all positions (RN, MD, and Ancillary) are scheduled based on volume and acuity by hour-of-the-day, sometimes referred to as demand-capacity staffing.
- Ensure there is a team focused on ED flow and a team focused on inpatient flow. Having these two teams aligned and united in their approach is ideal to create a push-pull model.
- Ensure the triage process is shortened and streamlined as much as possible. A triage is a function (not a place) and is not always necessary. If the next patient that arrives is going to go to Room 3 regardless of his condition, conducting a triage does little to expedite the process.
- Keep vertical patients vertical, and keep them moving. It is often a temptation to put everyone in a gown and have them lie down on a bed. This process is outdated and not necessary for every patient.
ED flow can become complicated, especially in large, busy, and urban departments. In many cases, bigger, more complex departments will require a deeper look into the operation and multiple factors affecting performance. Many hospitals have embraced Lean or Six Sigma methodologies as an option and have found success with such strategies for reducing overall turnaround times.
To Succeed, You Must Execute, Measure, and Communicate the Plan
A critical component of any successful change process includes a detailed and clearly written action plan. Leaders are much more likely to achieve their goals if their action steps are written. Leaders and team members can use the written plan as their roadmap and as one of the tools for tracking their success. Build into the plan specific elements that can be used as success measures to evaluate the impact and effectiveness of the plan.
Another important aspect of having a written plan is ensuring that the components of the plan are communicated widely, using several methods of communication. Some studies have suggested that it takes individuals up to seven times to see or hear something before they change behavior. Mentioning something just once at a staff meeting or in an email is not enough. Create a comprehensive communication plan in which a new change or idea is shared in many venues such as during huddles, in an email, in a newsletter, during rounding, etc.