Poster: Successful Strategies for Improving ED Throughput at Safety Net Hospitals
Title: Successful Strategies for Improving ED Throughput at Safety Net Hospitals
Presented by: Sari Siegel-Spieler, Ph.D., Assistant Vice President for Research, Essential Hospitals Institute/America's Essential Hospitals
Co-authors: Linda Cummings, Ph.D.; Kathryn A. Swink, MPH
The purpose of this study is to:
- ascertain quantitative benchmarks on key metrics for emergency department (ED) throughput and cycle time at public hospitals;
- identify top performing public hospitals based upon their scores on these benchmarks; and
- identify characteristics and strategies used by those high-performing public hospitals to improve patient flow and reduce ED overcrowding.
Public and safety net hospitals, many of which are members of America's Essential Hospitals, provide nearly three times more ED visits than other acute care hospitals nationally. Moreover, 55 percent of America's Essential Hospitals members are Level I trauma centers, and 33 percent have the only Level I trauma center in their county. With such high volumes of ED patients, effective throughput is key to reducing overcrowding in the ED and ensuring that each patient receives timely, high-quality care.
Together with UHC and with input from ED directors and senior administrators at America's Essential Hospitals member hospitals, the Essential Hospitals Institute adapted UHC’s 2006 benchmarking study, Managing Patient Flow in the Emergency Department and Operating Room for safety net hospitals. The Essential Hospitals Institute administered the survey to America's Essential Hospitals members (N=24); interviews were conducted with top performers to identify strategies used to improve ED throughput. Top performance was defined as scoring in the top 25th percentile on key metrics, including length of stay and time to admittance. Chi Square analyses were conducted using PASW/SPSS v.18.
Large, urban acute-care public safety net hospitals.
Top performance in ED throughput was correlated with:
- Having Trauma Level I ACS certification (p=0.042);
- Being located in the Northeast U.S. (p=0.000);
- Having an above-average number of ED treatment spaces (p=0.012); and
- Having an above-average number of nurses for each shift (p=0.012).
Strategies identified by top performers to improve ED throughput include:
- Creating a rapid assessment process;
- Increasing the numbers of nurses and other staff;
- Creating an inpatient overflow area;
- Creating an electronic inpatient bed management tracking system; and
- Promoting early discharge for all hospital patients.
The findings suggest that having a high number of staff, particularly RNs, social workers, and support staff working in the ED is highly correlated with top performance in ED throughput. The study concludes that by implementing the strategies used by top performing hospitals, it is possible to increase ED efficiency and patient flow.
Implications for Policy, Delivery or Practice
This study identified replicable strategies to reduce ED overcrowding and improve patient flow that are employed by high-performing large, urban, public safety net hospitals. Other hospitals and health systems can use insights from its findings to reduce ED overcrowding and improve patient flow in their facilities.
Primary Funding Source:
The Commonwealth Fund