This article is based on a 2018 Healthcare Analytics Summit (HAS 18) presentation given by Linda Hummel, MS, BSN, RN, Vice President of Quality and Patient Safety at Mission Health System and Rick Lee, MSN, RN, CEN, NE-BC, Executive Director of Emergency Services at Mission Health System, entitled “Transforming Emergency Care with Analytics and Technologies.”
More than half of all U.S. hospitals report over-crowding in the Emergency Department (ED), one-third report an increase in ambulance diversion, and 90 percent report they frequently operate at or over capacity, risking the ability to effectively provide emergency care to those who need it and contributing to patient dissatisfaction. Overcrowded EDs cause problems for both hospital patients and staff, such as increased wait times, length of stay (LOS), medical errors, and mortality rates, as well as financial losses to hospitals. A data-driven systems approach can dramatically improve every aspect of emergency care, improving wait times and throughput, reducing left without being seen rates, and improving patient satisfaction.
Crowding in the ED has become a widespread problem in hospitals across the country for two primary reasons: emergency medicine is the only specialty with a federal mandate to provide care to patients seeking treatment, and a shortage of primary care providers has forced more sick people to seek treatment in hospital emergency rooms. This overcrowding leads to a number of common problems with emergency care that can be seen as markers of hospital health.
These include the following problems with emergency care:
As the crisis of emergency care grows, hospitals have more pressure to make improvements in addition to the many other pressures facing the healthcare industry. Redesigning the delivery of emergency care involves a four-step approach.
To prevent the ED from operating in isolation, it’s necessary to involve hospital leadership and other frontline leaders in the improvement process. One way to do this is utilizing executive dashboards that show a snapshot of the ED performance on a regular (perhaps daily) basis. Dashboards might show the C-suite how many patients are in the ED, how many are waiting to be seen, wait times, and the number of behavioral health patients. One of the most telling metrics used in an executive dashboard is the longest wait time recorded or the longest wait time for a bed to be assigned to an admitted patient in the last 24 hours. Using executive dashboards can help keep stakeholders informed and involved. Increased leadership visibility and engagement can greatly contribute to success.
In addition to the daily snapshot, executives might be given access to look ED goals, past performance, patients left without being seen percentage, and admission trends. Using an emergency services application such as ED Explorer can help provide the data necessary to track, trend, and predict resources need in the delivery of quality emergency care. Additionally, a robust ED analytics application allows users to identify and quantify areas of opportunity in throughput, ancillary resource allocation, utilization, and quality.
What using an analytics application does is help users understand ED performance based on data. That data can then be used to predict and improve performance. For example, using analytics, ED leaders can better understand patient arrival times and their impact on ED throughput. This data can be surprisingly predictable. For instance, a hospital might find that if 30 or more patients arrive within one hour of each other, ED wait times skyrocket up to two hours. Then, if 30 or more patients are checked in within an hour, the analytics application can notify relevant stakeholders and departments about surging volumes in the ED. If the ED is the frontline, the imaging department might be the next department to experience large volumes–and wait times as a result. Additionally, notifying the relevant people can result in increased staffing when needed and prevent further congestion in other departments.
In looking to tackle Emergency Department quality improvement projects, hospitals should look for high-impact opportunities. Revising high impact workflows such as streamlining registration and provider triage can have real, impactful results on ED wait times, patients left without being seen percentage, and patient experience. Some of the workflow areas to focus on include the following:
With a robust analytics application, Emergency Department leaders can gain valuable insights into improving staffing patterns to maximize efficiency. What department leaders need to ask is “Do we have the right amount of staff at the right times in the right places?” What hospital leaders might be surprised to learn is that ED volumes can be surprisingly predictable. Using an analytics platform, healthcare leaders can gain use following insights into volumes to help inform their staffing patterns.
One hospital found that the busiest day of the year was the Monday following Super Bowl Sunday during a retrospective three-year review of ED census. Having access to this data and the ability to use it to identify trends, understand and respond to surges in volume, and predict the resources needed help improve the efficiency and quality of care provided in Emergency Departments.
Communicating leadership expectations is a crucial component of success. Because ED performance is a key indicator of hospital health, it’s necessary for hospital leaders to be actively engaged in the department and its improvement efforts. It may be helpful to identify an executive such as the Chief Nursing Officer or President of Quality and Safety as an Executive Sponsor for the improvement work. Additionally, it’s important to keep executives informed and involved through daily rounding, participation in surge calls if needed, and receiving daily ED performance reports.
As healthcare becomes more patient-centric, it’s more important than ever to improve the patient experience. According to Becker’s Hospital Review, improving patient satisfaction begins in the ED. In order to improve patient satisfaction in the ED, the quality of care must be consistent. Additionally, hospitals must purse patient feedback in order to identify high impact areas of focus. Below are some ideas for improving the patient experience in the ED:
Mission Health faced a number of challenges in its ability to deliver effective emergency services. Large numbers of patients were walking out of the ED without being seen by a provider, and, on average, patients waited more than 50 minutes to see a qualified medical provider. They embarked on an Emergency Department quality improvement mission to improve their patient flow, patient experience, and ED throughput with a data-driven approach. In a little over one year, they dramatically improved all aspects of ED throughput, including:
Although improving care in the ED is a high priority for many hospitals, it’s important to have realistic expectations and prepare for success. Emergency Department quality improvement is a journey that takes time and improving ED performance is much more than an emergency department initiative–it must involve the entire system of care. Additionally, using a data-driven approach can help engage stakeholders and make a compelling case for change. Changing the entire system of care requires excellent leadership and leaders need to pace themselves so they can effectively lead the change.
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Would you like to use or share these concepts? Download the presentation highlighting the key main points.