What lies behind the ED Doors?

In the first of a three part series dealing with patient
throughput issues, we’ll examine the unique set of
circumstances that impact throughput and satisfaction
when a patient enters your organization through the
ED portal.

THE EMERGENCY DEPARTMENT

is the financial lifeblood of the hospital, bringing in a large portion of admissions and revenues, both directly as a result of ED treatment, and indirectly through inpatient treatment, surgeries, and other services. Although the number of ED visits has risen over 20% in the last decade, according to a 2005 AHA study, over 70% of hospitals reported some time on diversion, in which ambulances (and revenues) are turned away. Patient backups in the ED prevent the input of new patients, hurting the hospital's revenue potential.

Bottlenecks may result from a wide variety of factors within and outside the hospital. These range from the triage processes used within the ED, how the socioeconomic makeup of the patient population affects ED demand, and scheduling and discharge issues in other areas of the hospital. Many organizations have introduced sophisticated process management tools to fix problems inside the confines of the ED, but this doesn't address root causes in other areas of the hospital.The only approach that has shown promise is the implementation of comprehensive, system-wide process improvements that bring departments together, with each understanding the ways that their actions impact one another.

CROTHALL'S IMPROVED PROCESS

The basic flow diagram (center) illustrates the typical path in the ED patient experience and how it can be impacted by these problems. Crothall's Patient Throughput solutions involve service specialists from both the Patient Transportation and Environmental Services departments, who understand the complexities of moving a patient through each step. Crothall's programs optimize tasks to create the most significant improvement in the overall process flow for our clients.

It comes as no surprise that the most prevalent challenge to throughput is lack of critical care beds.To address this, Crothall's program focuses on bed turnaround. Crothall has the systems to benchmark the completion times for each step in the room cleaning process, and institute training to perform each step in the most efficient manner. This program has been extremely successful at Lehigh Valley Hospital, which had struggled with throughput challenges.

LEHIGH VALLEY HOSPITAL'S SOLUTION

Crothall has had success assisting LVH in the creation of Discharge Bed SWAT Teams. LVH Vice President of Operations Mark Holtz explains,"The DBST was a critical component of a capacity throughput project that began in 2003. Crothall was instrumental in blending its talent and oversight of the bed cleaning process and partnered with us to create an excellent team. They even came up with the creative incentives that enhanced performance across the board. As a result, turnaround time for when a patient's bed was empty until cleaned and ready for the next patient was reduced from an average of 210 minutes to around 60 minutes."

With similar attention to other major bottlenecks in patient flow within the hospital, additional improvements can be made. Together, these process improvements form a Patient Throughput program that not only improves the hospital's opportunity for revenue, but also creates a more efficient and enjoyable patient experience. Only Crothall has the leadership, processes, and software to deliver this comprehensive program.