Emergency Department

CDC: Progress being made in infection control in U.S. hospitals

As hospitals' focus on reducing infections has intensified, central line-associated bloodstream infections fell by 46 percent between 2008 and 2013, according to the National and State Healthcare-Associated Infections Progress Report released by the Centers for Disease Control and Prevention.

The hospital CEO's ultimate dashboard: What to check each day, quarter and year

Patient Satisfaction guru Quint Studer describes the CEO's "ultimate" dashboard in a recent Becker's Hospital Review article. The dashboard is a concise selection of metrics for laser-focusing on the issues that drive results. These metrics fall into four "buckets": productivity, volume, clinical quality and service.

Laboratory Cost Improvement: Achieve cost savings using labor productivity and expense

This recent presentation provides an approach for labor and non-labor cost reduction using internal and external benchmarks. The benchmarks are based on extensive experience by the author's organization. The presentation includes productivity benchmarks for the various types of specialties within the typical hospital lab.

Fancy hospitals often fail to impress patients

Hospital executives across the country have justified expensive renovation and expansion projects believing they will lead to better patient reviews and recommendations. Patient satisfaction has become even more important since Medicare started to base some of its reimbursement on patient surveys.

Many medicare quality bonuses wiped out by penalties

Of the hospitals graded by Medicare on quality, 1,700 (55 percent) received bonuses for providing comparatively good care based on such criteria as patient satisfaction.

Five traits of high reliability organizations: How to hardwire each in your organization

In this article, healthcare patient satisfaction guru, Quint Studer, advocates that healthcare organizations look to industries that have taken on the concept of high reliability as a central operating focus to dramatically improve patient safety.

Freestanding Emergency Departments

This white paper from the New York State Department of Health describes operational differences between freestanding emergency department and urgent care centers and gives pros and cons compared with hospital-based emergency departments.

ER Wait Watcher - Which emergency room will see you the fastest?

The PRO Publica website shows current and average wait and service times for most hospitals in the U.S. and roll-ups by state. How does your hospital stack up?

How big data helped cut emergency room visits by 10 percent

Starting in 2012, Washington emergency rooms began tracking patients in a mandatory, statewide database as part of an effort to supply the necessary health information to divert patients from trips to emergency rooms for non-urgent problems. Dr. Nathan Schlicher, an ER doctor who serves on the board of the Washington State Medical Association, said the Emergency Department Information Exchange has given hospitals a way to monitor patients and keep hospitals up-to-date regarding patients' health records.

Top-five list to improve emergency medicine and reduce costs

The Daily Rx summarizes on a study led by Dr. Jeremiah D. Schuur, an emergency medicine specialist at Brigham and Women's Hospital in Boston, to reduce excess utilization and costs in the Emergency Department.

Re-engineering the operating room using variability methodology to improve health care value

This is a summary presentation of one year results from a project at Mayo Clinic in Florida aimed at improving the operational performance of a hospital's operating rooms by assessing and managing variability. The changes resulted in a 5 per cent increase in OR utilization and net revenue and a 27 percent reduction in overtime. These data were also published in the June 2013 Journal of The American College of Surgeons.

Emergency department staffing: When is the right time to add provider coverage? Medical scribes vs. PAs/NPs

This article promotes using scribes as a cost-effective alternative to adding physician, nurse practitioners or physician assistant staffing in the emergency department.

Efficient clinical workflows enhance user acceptance and other EHR benefits

A presentation at the 2013 SHS Healthcare Systems Process Improvement Conference
Hospitals and health systems spend millions of dollars to acquire and meaningfully use certified EMRS and EHRS nationwide. This presentation from HSPIC 2013 describes a for-profit health system's experience in deploying efficient workflows that lead to increased acceptance and usage by physicians and other stakeholders to realize many benefits including receiving CMS incentives.

Reducing patient charges by eliminating amylase from lab panels - HBR Blog Network

One hospital was able to reduce patient charges by over $300,000 annually by reducing the frequency of amylase and lipase testing for ED patients with abdominal pain and other conditions.

Here's how a Cincinnati ER cut its wait time by 70 percent - The Cincinnati Business Courier

Dr. Stephen Feagins, vice president of medical affairs, describes how ER wait times were reduced by 70 percent at Mercy Health's Anderson Hospital in an interview with the Cincinnati Business Courier. 

Is Your ED Optimized? Advanced Healthcare Network Executive Insight

Dr. Crane addresses a host of issues in this article for improving ED performance including the application of queuing theory, demand matching, and more frequent budgeting.

Staffing an ED appropriately and efficiently, ACEP News

Much attention is given to RN and other support staffing in the Emergency Department while neglecting to look at ED provider staffing. This article in ACEP News gives some recommendations for provider staffing that may be the most important driver of patient throughput in your ED.

Modeling and optimizing emergency department workflow

The authors of this presentation describe how industrial engineering research improved patient access and reduced cost by applying a machine learning simulation approach at Grady Health System in Atlanta. 

 How we revolutionized our Emergency Department

This article in the Harvard Business Review describes how one emergency department went from the sixth to the 99th percentile in patient satisfaction using a lean framework to eliminate waste. 

 Emergency department staffing - when is the right time to add provider coverage? Medical Scribes vs. PAs/NPs

This article promotes using scribes as a cost-effective alternative to adding physician, nurse practitioners, or physician assistant staffing in the emergency department. 

Tools, techniques, and best practices in the emergency room

Long waits in the waiting room, patients leaving without being seen, patients boarding and holding in the ED, delayed test results, and diversions. Have you encountered these issues in your ED? This presentation from a prior SHS Conference highlights improvements through several ED projects at HCA and will provide you with a sample of the tools utilized, results, best practices, and lessons learned.

How to conduct the perfect emergency department staffing study

This paper, presented at a previous Society for Health Systems Conference, provides a detailed approach to determining emergency department staffing needs.

The leaving without treatment reduction plan success story: Advocate Trinity

An improvement team at Advocate Trinity Hospital in Chicago addressed the issue of a high rate of "left without being seen." This presentation at the Healthcare Systems Improvement Conference 2012 describes how an improvement team used information systems and analytical approaches to gather information on the root causes for problems and potential solutions in the ED. Leadership rounding throughout the ED, establishing effective treatment protocols and finally, front loading medical orders to help expedite patient treatment and prompt patient disposition. After implementation of the above planned measures, the LWOT percentage reduced from the highest rate of 12.4 percent in July 2009 to 1.1 percent in June 2011.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article 

Evolution of the ED

This recent article from the American Institute of Architects describes progressive improvements to ED design from the author's perspective. Examples of this evolution are provided from University Hospital in Cincinnati, Strong Memorial Hospital, Marymount Hospital, and University of Pittsburgh Mercy Hospital.

Forecasting models of Emergency Department crowding 

This paper, published by the Society for Academic Emergency Medicine, compares seasonally adjusted and sinusoidal models against historical hourly averages for four- and 12-hour advance census forecasts. The authors conclude that the two more advanced methods are more robust than historical averages. 

Emergency department patient flow: The influence of hospital census variables on emergency department length of stay

This study from the Academic Emergency Medicine organization of more than 25,000 admissions at five different hospitals found that that there is a moderately strong correlation between ED length of stay and inpatient census of ICU and telemetry units. This study infers that reducing inpatient occupancy rates may be an effective way to reduce ED length of stay.

A novel approach to identifying targets for cost reduction in the emergency department 

Hospitals would save more money by reducing avoidable patient admissions from the ED than by preventing non-urgent ED visits, according to a study (abstract only) in the Annals of Emergency Medicine. Researchers found that the cost of expanding urgent care centers or extending primary care hours would offset these savings of reducing minor injury and illness visits to the ED. However, substantial benefits could be realized by investing in systems that reduce ED admissions through comprehensive patient-centered care.

Emergency Department of the Future - Penn State University at Hershey

This YouTube video shows some details of how Penn State University at Hershey implemented a no-wait ED with physician directed queuing (PDQ). The changes allow the ED to treat 50,000 patient annually in an area designed for 30,000 visits.

Improving patient flow and reducing emergency department crowding: A guide for hospitals

The Agency for Healthcare Research and Quality recently released this publication providing many practical approaches to reducing emergency room overcrowding.

Improving pediatric emergency department patient throughput and operational performance

A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.

University of Windsor Industrial and Manufacturing Systems Engineering students help to improve lab processes in the ED at Sunnybrook Helath Sciences Centre

Sunnybrook Health Sciences Centre is considering implementing recommendations made by three fourth-year students at the University of Windsor Industrial and Manufacturing Systems Engineering as part of their capstone project. Ben de Mendonca, Josh Vandermeer and Andrew Phibbs, conducted an intensive examination of the system used by the emergency department to collect and label patient blood samples.

Study finds high quality hospitals deliver trauma care at lower cost

A recent study in the Annals of Surgery found that high quality hospitals deliver lower cost care to trauma patients, according to a news release by the University of Rochester Medical Center.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

Case study on patient flow improvement, streamlining admissions from the emergency department

In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow.

Texas Tech industrial engineering researchers reduce ED waits and discharge delays at Odessa's Medical Center Hospital

Industrial engineering principles are applied in improving patient flow at Odessa's Medical Center Hospital in Texas.

Emergency department operations: The basis for developing a simulation tool 

In this paper originally published in IIE Transactions, the authors describe a foundational approach for simulation modeling of emergency departments that is general, simple, intuitive and easy to use. 

Canadian Study Shows Left Without Being Seen Emergency Department Patients Not at Increased Risk for Adverse Events 

The results of a Canadian study published last year in ACEP News (American College of Emergency Physicians).

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient.  The visit quality as perceived by the patient increases with fewer communications.

SHS Redesigning Emergency Department Care Delivery Focusing on Patient Safety

An ED is redesigned after patient flows were modelled using queuing theory.

SHS Simulation Medication: Studies Show Patient Flow Improvement

The process of creating and achieving approval of an ED simulation is discussed.

SHS Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

SHS Utilizing Industrial Engineering Student Teams to Benefit Management Engineering Efforts

An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.

SHS Building Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

SHS In the Quest for Performance Excellence: Deployment of Lean Manufacturing Principles in Healthcare Delivery Processes

Three successful lean projects are discussed in detail.  The ED, Radiology, and HR departments all show significant improvement.

SHS Improving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed

SHS Enhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

SHS The Journey Toward a Lean ED

A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases.  Simulation shows further viability of new processes.  This presentation is made by a MD who became a lean coach.

SHS Applying Redesign Principles to Design ED and Hospital Patient Flow Processes

This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.

SHS A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed.  The presenter is a MD.  Several changes are shown with great results.

SHS Turning the ED into Your Hospital's New Front Door

Multiple projects are performed to improve an ED.  Problems are stated and results are given.

SHS Design the Greatest Emergency Department - Applying Basic & Advanced Lean Healthcare Tools!

The author facilitates a lean educational journey through an ED.

SHS Size Matters; How Big Does Your ED Need to Be?

A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.

SHS Applying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

SHS Capturing Supply Charges in the Emergency Department: How and Why?

ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.