Throughput and Satisfaction in the ED

Michael Zeis, for HealthLeaders Media , May 15, 2014

Peter P. Semczuk, DDS, MPH, vice president of clinical services at Bronx, N.Y.–based Montefiore Medical Center, which operates six hospitals on five campuses, including the 745-bed Montefiore Medical Center, says, "One of the things that keeps me up at night, that's absolutely top of mind, that I worry about all the time, is patients that are left in the waiting room. It really frightens me because bad things happen to patients in waiting rooms. We want you inside, around the clinical team that's caring for you."

Joseph S. Prosser, MD, MBA, CPE, FACPE, vice president and chief medical officer of Texas Health Harris Methodist Hospital Fort Worth and three other hospitals in the Texas Health Resources system, conveys a similar sentiment: "Our mission is to have no patient wait in the waiting room."

At Montefiore and elsewhere, stationing experienced clinical staffers right in the waiting room is a way of ensuring that those who need care the most will get timely attention. "We think the triage process should begin in the waiting room," says Montefiore's Semczuk. "I think that is the single most important thing that we can do as ED leaders to increase efficiency." Doing triage in the waiting room has another benefit besides launching patient flow and treatment. "The biggest benefit," he observes, "is you've got someone watching patients all the time while they're waiting."

Focus on patient flow

One way or another, care at virtually all EDs starts with triage. Nearly three-quarters of respondents (72%) say their triage activity supports ED throughput efficiency. Streamlined registration (63%) and channeling low-acuity patients to a fast-track area (65%) are other leading techniques to increase throughput efficiency.

On the top of the list of efficiency techniques to institute next: 38% expect to speed up transfers for patients to be admitted. ED-to-inpatient transfer is the bottleneck identified most frequently, by 61% of survey respondents, including 69% of those who characterize their ED as always or often overcrowded. "If I look back at the challenging cases we've had in the last year or so, almost every single one of them have to do with an admitted patient that was waiting a prolonged period of time for an inpatient bed," says Semczuk, lead advisor for this Intelligence Report.

Prosser from Texas Health Harris Methodist Hospital Fort Worth says its team pursues transfer or discharge from the very beginning: "We are doing discharge planning from the moment a patient comes in the emergency room." To make room for more ED patients when inpatient occupancy is high, Texas Health admits certain patients who then occupy screened-off hallway beds. Says Prosser, an advisor for this report, "That way we can get a patient out of the emergency department and take them up to the floor until a bed opens up. The patients actually want to do that—they want to get out of the emergency room and upstairs in the hospital where they're being managed by nurses and staff that are familiar with their pathophysiology."

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