ED Wait Times Improving for the first time in 40 years
Jim J. Augustine, MD, FACEP, Director of Clinical Operations for Emergency Medicine Physicians, posted recently as a guest blogger on Press Ganey's Improving Health Care blog. Below is a portion of Dr. Augustine's thoughtful assessment of how improvements in ED care can and have been achieved by focusing on flow, operations and safety.
- (1888PressRelease) May 18, 2011 - For most hospital patients, that sliding glass door marked "Emergency" is the hospital's true entrance. The other front door, of course, is the main lobby, where mostly scheduled patients arrive for surgery or other services. In the past 40 years, however, the action has shifted to emergency care. In fact, the emergency department is the hub of what you might call the "Unscheduled Care System."
Actual emergency room wait times (not perceived wait times) are beginning to shorten, probably for the first time in 40 years. Busy EDs have instituted a Physician First program, which has an emergency physician participate in the patient-greeting process, shortening the time to initiation of care and improving flow throughout the department. Enlightened hospitals have incorporated Lean processing programs to reduce the time in the ED for admitted patients. The Centers for Medicare and Medicaid Services is so interested in this process that it will be asking hospitals to report the door-to-door times for admitted patients and putting that data on public web sites in 2013.
Research conducted by the Emergency Department Benchmarking Alliance in 412 hospitals that saw over 16 million patients indicates that ED processing times (door-to-door) from 2008 to 2009 had fallen from 188 to 166 minutes for all patients. And for patients who are treated and released, the median length of stay decreased from 159 to 146 minutes. There has also been a decrease in the number of patients who leave without being seen or treated. The decrease in emergency department stays for admitted patients is critically important because in 2009, hospitals reported that 66% of inpatients arrived through the ED. This is all positive news.
Dr. Augustine summarizes that work being done by ED leaders across the U.S. has focused on a handful of key tactics in recent years:
• Reducing wait time to see the doc and to get a bed.
• Avoiding Diversion.
• Providing Rapid greeting.
• Having sufficient patient care rooms to provide care in a room - not a hallway.
• Reducing turnover of ED personnel.
• Enhancing on-call specialty services.
• Ensuring that computerized documentation systems be optimized for healthcare workers.
• Preparing for patient surges in situations such as H1N1outbreak and natural disasters.
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