Tools for Improving Emergency Department Efficiency
A solutions-oriented discussion around today’s ED operational issues
Considered one of the nation’s leading experts in emergency department operations, Dr. Jody Crane, TeamHealth’s chief medical officer, shares his insights on ways hospitals can improve the overall efficiency of their emergency departments.
DR. CRANE, IN YOUR EXPERIENCE, WHAT ARE SOME FIRST STEPS EMERGENCY DEPARTMENT LEADERS CAN TAKE TO BEGIN TO ADDRESS INEFFICIENCY?
JC: At some point, every hospital has to address ED efficiency, and one of the easiest ways to begin that analysis is to segment your patient mix, considering volume and acuity mix. The concept of segmentation actually originates from Lean Healthcare design. Lean tools are invaluable in helping hospitals accommodate volume growth, reduce waste, enhance value and improve the patient experience. Segmentation of patients into low, medium and high acuity streams allows you to provide a more customized experience based on a patient’s specific needs while enabling the hospital to reduce variation and waste. In the end, customized strategies for various patient streams allow your emergency department to be more cost effective and more productive with the same resources which translates into a more satisfying experience for your patients and a more engaged clinical workforce.
HOW DOES A HOSPITAL BEGIN TO IMPROVE ED OPERATIONS?
JC: For most hospitals, the best place to start is an honest appraisal of the issues affecting your emergency department, including an assessment of the organization’s culture and willingness to champion change over a sustained period of time. In an engagement with a 70,000-visit ED, the waiting room was packed every night and the percentage of patients leaving without being seen by providers was very high. So we started by asking ourselves some very basic questions in an open, collaborative approach: Who is in the waiting room? When and why are they walking out? What are our bottlenecks? The answers led a consolidated effort and working together, we began to see remarkable improvement! The walkout rate declined dramatically, other metrics improved markedly and our patient satisfaction skyrocketed!
DR. CRANE, YOU WERE A PIONEER IN THE CREATION OF THE “SUPERTRACK” CONCEPT YEARS AGO; A CONCEPT THAT MANY HOSPITALS CONTINUE TO BENEFIT FROM TODAY. HOW DOES THAT CONCEPT WORK?
JC: I happen to think that the concept of the SuperTrack is literally one of the most valuable things a hospital can implement. It is a streamlined operational approach to ESI (Emergency Severity Index) 4 and 5 patients where they are seen, treated, and released, all from one or two beds right in triage. This concept forces you to look critically at your patient mix – the ESI levels you treat, arrival patterns, capacity issues, and bottlenecks. The concept that we developed back in the early 2000s has been replicated at hospitals across the country, and I can honestly say, the only time I haven’t seen this concept work is when the organization was not culturally engaged to prioritize low acuity patients. By implementing these concepts, I’ve seen as much as a 50% increase in productivity by eliminating waste and inefficiencies. And the bestpart is, we aren’t pushing people to work harder; we’re simply compressing their work into a smaller, more coordinated footprint.
SPEAKING OF CLINICIANS AND THE ED WORKFORCE, WHAT IS THE IMPACT ON CLINICIAN ENGAGEMENT, RETENTION AND OTHER FACTORS?
JC: Better patient care is at the heart of improvements to your emergency department processes, obviously, but there are also benefits that positively impact clinician engagement, retention, reduce burnout and other factors that relate to your workforce. Improving your ED’s efficiency is also about creating a work environment where your clinicians, nursing staff and everyone involved can do their best work – the work they are passionate about.
HOW CAN TEAMHEALTH HELP A HOSPITAL THAT IS ADDRESSING THROUGHPUT AND EFFICIENCY CHALLENGES?
JC: ED staffing and operational excellence is a cornerstone of what we provide. This year, TeamHealth celebrates its 40th anniversary, dating back to our founding in 1979 with a single emergency department contract. We provide stable, high-performing teams of highly qualified physicians and advanced practice clinicians, and pair them with seasoned, experienced operational leaders and experts in performance improvement who can provide critical insight and guidance to improve an emergency department’s core metrics.●