Improving the ED

Margaret Dick Tocknell, for HealthLeaders Media , May 13, 2013
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Less than half of the survey respondents (44%) identified standardized handoff protocols as a method they use to increase ED throughput efficiency. That surprised Priest. "Much of the stuff that goes into the ED has pretty standard complaints. If you could figure out how to use predetermined evaluations, you could often have lab tests or x-rays done before the patient gets to the main ED area." Priest suggests placing a physician or a nurse practitioner in a triage area to take brief patient histories and order diagnostic tests according to protocol. The protocols can "help reduce wait time between triage to ED room, to ED physician, to test area, and to test back."

 Still, Sayah cautions that these techniques are only a part of the solution. "Those things work, but they don't work by themselves. They've been used for years and yet here we are today with overcrowding and long waits. What's missing? The ultimate solution needs to be a hospitalwide commitment to relieving the ED from being overcrowded, which includes rapid admission and rapid throughput."

 Also important, says Sayah, is to get a C-suite commitment to help with immediate, one-off solutions. When all else fails, even in the middle of the night, the ED needs to be able to turn to the "three or four people within the hospital with the authority to escalate processes across the entire hospital system."

Half of the healthcare leaders (50%) identified better nurse workload balancing as the most effective staffing technique to increase ED throughput efficiency. This response reinforces the systemic relationship the ED has with other hospital departments and functions.

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