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Eventually, hospitals will develop geriatric EDs, just as many now have pediatric EDs, predicts Lowell Gerson, PhD, professor of epidemiology at Northeastern Ohio University College of Medicine in Rootstown.
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A new report from the Urgent Matters Learning Network, Bursting at the Seams: Improving Patient Flow to Help Americas Emergency Departments, identifies best practices from 10 hospitals selected as participants in an initiative to help hospitals eliminate ED crowding. Each participating hospital developed and implemented strategies to improve patient flow through the ED and to reduce overcrowding. EDM looks behind the results to the strategies and methods that achieved them. With this issue, we begin a series of articles that will examine just what made these programs special and successful.
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It may seem logical to blame your overcrowding problems on understaffing, but as the ED staff at the 302-bed North Shore University Hospital at Forest Hills in Queens, NY, found out, that may not always lead you to the root of your problems. Learning that lesson, and finding the real cause of their problems, enabled them to slash their average cycle time from 187 minutes to 118 minutes.
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The Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare & Medicaid Services (CMS) have been working to align their common national hospital performance in the areas of acute myocardial infarction, heart failure, pneumonia, and surgical infection prevention.
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As the ED staff at Lehigh Valley Hospital in Allen-town, PA, have learned, its how you respond to benchmarking data that determines success. For example, to speed up admissions, it was necessary to address virtual capacity issues.
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Hsu J, Reed M, Brand R, et al. Cost sharing: Patient knowledge and effects on seeking emergency department care. Med Care 2004; 42:290-296. Saketkhoo DD, Bhargavan M, Sunshine JH, et al. Emergency department image interpretation services at private community hospitals. Radiology 2004; 231:190-197. Lyons MS, Lindsell CJ, Trott AT. Emergency department pelvic examination and Pap testing: Addressing patient misperceptions. Acad Emerg Med 2004; 11:405-408.
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An analysis tool commonly used for investigating adverse events and other process errors in health care can prove useful in the ED as well, say experts who have seen it used to address long wait times and similar problems. The technique is called root-cause analysis (RCA), and chances are youve heard the term tossed around, but its not as likely that youve actually employed it in the ED.
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A root-cause analysis (RCA) is a complex tool that requires professional training, but an ED manager can utilize it with the help of an expert, says Kenneth A. Hirsch, MD, PhD, a practicing psychiatrist and director of Medical Risk Management Associates, a consulting firm in Honolulu.
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In addition to increased numbers of mentally ill patients, EDs are seeing more uninsured patients than in the past, and the numbers could grow, warns Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX. Your budget planning should factor in more uninsured patients, not just the same level you have coped with for years.
