the Emergency Room
By: Jessica Comerford,
Have you ever?
Gone to the ER and had to sit and wait for
hours before being seen?
Left an emergency room with unsatisfied
Felt rushed or ignored in an emergency
In-Efficiency in the Emergency Room
Over the last decade, more and more Emergency departments are suffering from “overcrowding “
There are many factors that contribute to this ongoing problem, among some of the more
prevalent issues are:
Non emergency patients receiving “care “ at the emergency room causing overcrowding and
poor utilization of resources. Especially over the last few years, with the changes occurring in
the health care industry,
The high flow of uninsured patients
Utilization of the ER for prescription fills and pain management
Uneducated discharged patients after shortened shortened hospital stays.
WHY IS THIS SUCH A PROBLEM?
The in-efficiency of today’s emergency rooms has an impact on all areas of
patient care, including quality of care, access of care and wait time for care
which all greatly affect customer satisfaction.
Patient Satisfaction by Time Spent in ED
0 to 1
1 to 2
2 to 3
3 to 4
4 to 5
5 to 6
Annual ED visits have increased in the past 10 years from 90.3 to 119.2 million
(32% increase). With the new healthcare bill it is expected that the average ED
will have increased volume of 6,500 patient visits.
Number of ED’s have decreased 4019 to 3833, a 7% loss.
Less ED’s and more ED visits have resulted in ED overcrowding.
Pain has been deemed the “fifth vital sign” that should be routinely monitored.
It is one of the leading complaints for patients in the emergency department.
Knox, T. MD, MPH, Medscape Emergency Medicine. 2009 Mount Sinai School of
Medicine reported a study of ED overcrowding and pain management.
The authors showed at peak census, that on average, patients waited 55
minutes longer for pain assessments and 43 minutes longer to receive
analgesics. Hwang, U. Acad. Emergency Medicine 2008; 15: 1248 –1255
Patients admitted during high ED crowding have 5% greater risk of dying
December 6, 2012 | By Alicia Caramenico
High emergency department crowding is associated with increased
inpatient mortality, as well as moderate rises in length of stay and costs,
concludes a new study in the Annals of Emergency Medicine.
Patients admitted to the hospital during high ED crowding times had 5
percent greater risk of inpatient death than similar patients admitted to
the same hospital when the ED was less crowded.
The researchers looked at almost 1 million ED visits resulting in admission to 187 hospitals and used
daily ambulance diversion to measure ED crowding, according to a research announcement today.
They found that on days with a median of seven ambulance diversion hours, admitted patients had a 0.8
percent longer hospital length of stay and 1 percent higher costs.
S Improve ED efficiency by improving patient
flow, maximizing resources, developing community
based patient education, and implementing a change
Questions that need to be ask?
S Is there enough capacity?
S What is the resource utilization rate?
S What causes patients wait times?
S What is the throughput rate and time?
S What is the best possible solution(s)?
Assess ED visits by acuity and wait times for use when structuring a patient flow
Develop educational programs with the hospital discharge department and the
community health leaders.
Create and promote ambulatory programs for patients who require non emergent
Establish a SOP- standard operating procedure to assist in streamlining patient
flow incorporating innovative ideas and creative solutions including an electronic
Establish a Performance Improvement program that monitors and reports out
monthly metrics addressing wait time, expected outcomes, admissions, mortality
and customer satisfaction
Develop a culture where Change management , metric review and customer
satisfaction is the focus.
Designate Triage areas for patient based on acuity.
Develop and implement customer satisfaction surveys for patients to provide
feedback for the ED.
Facilitating Change, Anticipating
Facilitating change often involves anticipating common challenges and taking steps to
forestall them. We recommend several strategies for addressing those: challenges
Constant reinforcement of the
strategy by leaders
Signals to staff that the improvement
strategy will become standard procedure
Provides staff with the capabilities and
knowledge to carry out the strategy
Signals responsiveness to staff concerns
and lack of
Use of Lean quality
Fosters a team environment
Lack of staffing
Robust data collection
Provides concrete evidence of need for
action; demonstrates success to hospital
leaders and frontline staff; is crucial in
Production VS Quality
S When it comes to being productive hospitals are at the bottom of the list. They
do try but the patient numbers are always increasing at a random rate
S After the input of some strategies we want to make sure we utilize them to the
best of our abilities.
S We want patients to be satisfied and cared for in a timely fashion.
S But we also want each and every single patient to be treated in the right
manner with 100% quality.
S Hospitals need a good balance of excellent patient treatment but also getting it
done in a timely fashion. Dr.’s shouldn’t just rush a patient out of the room
because they feel their problem isn’t a life threatening issue
Productivity vs. Quality
S Resource Utilization will
be more tightly
S A decrease in un-
, Unnecessary testing
will be monitored and
S Health Care reforms
has structured a “pay
S Quality outcomes will
be reimbursed higher.
S Readmissions to the
hospital will not be