How an Improved Patient Flow Process Makes Your ED Safer

An optimized patient flow process offers several benefits for the emergency department. For example, efficient patient flow allows EDs to manage increased patient volume and throughput. It also reduces the costs incurred by EDs as a result of extended lengths of stay and boarding. EDs with an established and sound patient flow process experience higher staff morale and increased levels of patient satisfaction. Most importantly, improving patient flow increases patient safety in the emergency department, which is critical for ED and hospital leaders focused on patient experience.

We can all agree that emergency department crowding is, by and large, the greatest threat to patient safety. I discussed this correlation in a recent blog post, but I wanted to take some time to talk more about how an optimized patient flow process counters overcrowding and will lead to improved safety in the emergency department.

For patients experiencing life-threatening conditions— such as strokes, heart attacks and trauma — time is of the essence. Staff also must be able to have the confidence that bottlenecks or barriers to care do not appear when treating patients with these conditions. Inefficiencies in the ED may place undue stress on nurses, physicians and support and result in increased workloads, all of which pose a threat to patient safety. But when an optimized patient flow process is in place, ED and hospital leaders can be assured their patients will receive complete, comprehensive care without a risk to staff morale and patient safety.  

ED leaders must also understand the effects of bottlenecks and barriers to care in the ED can put a strain on other areas of the hospital, such as inpatient units. Rapidly admitting patients to inpatient units does little good if no beds are available. Efficiency isn’t really about the speed in which an ED admits, discharges or transfers a patient. It’s about providing quality care that’s appropriate while effectively managing the expectations of patients and their families along with relevant staff stationed throughout the hospital. If the ED is the front door of the hospital, it’s also where the flow of patients begins and the foundation for a culture of patient safety.

Delivering quality care promptly within the ED isn’t the only factor that contributes to this culture of patient safety. Effective communication and teamwork is also critical to patient safety and patient flow. Miscommunication takes an immense toll on an ED’s tally of preventable medical errors. If you’re an ED or hospital leader who has made the wise decision to revamp an inefficient patient flow process, make sure your communication strategy is tailored to the new plan. Communication is especially important during the implementation of any new or updated plan, no matter the performance areas you’re focusing on. Open-door policies, standardized communication practices and deep analysis of existing and potential communication structures are all proven strategies to increase patient safety and improve patient flow.

Need help improving your ED’s patient flow? Schedule a complimentary phone consultation with Connie Donovan to discuss what’s happening in your ED.

SOURCES:

Agency for Healthcare Research and Quality: “Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals”

Agency for Healthcare Research and Quality: Patient Safety and Quality: An Evidence-Based Handbook for Nurses

How an Interim Management Consultant Adds Value to a Hospital and its ED

Emergency departments are complex care delivery systems with many interdependent components such as medical and support staff, inpatient and ancillary services and the community they serve.

CEOs, CNOs, COOs and CFOs rely on ED leadership and management teams to ensure clinical operations are aligned with quality and patient safety initiatives, value-based reimbursements and patient experience demands. And even though your emergency department may have great managers and directors on staff, it may need to be energized with temporary assistance. 

Working with an ED interim management consultant can help engage your current leadership team and bolster internal resources with additional experience and talent. ED interim management consultants are experienced emergency department leaders with deep clinical operational, financial and regulatory-accreditation experience. They support existing hospital management and leadership, providing clinical processes and tools to optimize what is working well. They also identify inefficiencies in the ED and then develop and implement practical, customized solutions to combat them. 

Whether it’s for one week or three months, the benefits and practical knowledge these consultants bring to the emergency department are immense. Here are a few ways interim management consultants add value to a hospital and its emergency department.

Improved clinical operational performance and patient experience.

Interim management consultants establish a strong foundation within your ED to strengthen clinical operations for value-based reimbursement. By focusing on staffing and scheduling effectiveness, as well as patient flow, they can improve clinical operations and heighten patient experience. Interim management consultants will also develop and implement a comprehensive and sustainable improvement plan and build upon current strategies to craft long-term improvements.

Stability.

At times your hospital may have an ED management vacancy, which may result in unnecessary disruptions. By filling the vacancy with an interim management consultant, ED leaders can ensure continued progress on any initiatives and reduce the likelihood of any communication breakdowns. They can ensure that new, incoming managers are brought up to speed while providing stability to existing ED staff. They’ll also engage your team and openly communicate goals, actions, timelines and milestones.  

Time. 

It’s important to act fast when filling an open leadership position, but finding the right person takes time. Interim management consultants allow you to devote more time and energy to finding the perfect permanent replacement. 

A fresh perspective.

Interim management consultants are often able to identify problems or issues that have previously gone undetected in an emergency department. The fresh pair of eyes interim management consultants lend to EDs can quickly spot inefficiencies in the patient flow process and any issues that could cause harm to patient safety initiatives. And, drawing from their vast experience in the field, they will be able to develop and implement innovative and creative solutions promptly.

Experience and solutions.

Even the highest-rated EDs have room for improvement, whether it’s a leaving without being seen rate that’s slightly above the national average or a bottleneck in the patient flow process that results in an unnecessary increase in lengths of stay. The best interim management consultants seek ways to strengthen these areas in the emergency department, maintaining high expectations when it comes to quality of care, patient satisfaction and patient safety – always ensuring that goals are aligned with their client’s business and patient care objectives. To do this, they draw from their wealth of experience to improve the quality of care EDs provide. 

When your current staff and leadership need a boost, or you experience a vacancy in your leadership team, interim management consultants like myself can help sustain the infrastructure of your emergency department while continuing to improve the patient experience. Donovan and Partners always keeps patient quality and safety in mind when working with emergency departments no matter their needs and the amount of time we spend with them. That’s why we work hand in hand with existing leadership to make transitions seamless and ensure operations continue to run smoothly, even when leadership positions are in question.

3 Ways to Identify At-Risk Patients in Your Emergency Department

Nurse having conversation with patient

Successfully identifying at-risk patients is a challenge facing many busy emergency departments today. These patients — who often suffer from substance abuse or mental health issues — need long-term care EDs aren’t equipped to offer. But in many instances, the treatment provided by emergency department staff and physicians is the only care at-risk patients receive, resulting in a revolving door of frequent ED use.

The first step to providing at-risk patients the care they need is to identify them as such. And for EDs looking to improve patient flow and reduce crowding, identifying at-risk patients is crucial. Connecting these patients with appropriate care providers in the community will lead to earlier diagnosis, ease access to treatment and increase the likelihood of a positive outcome for patients, all while reducing the odds of a return visit to the ED.   

Here are a few ways staff can identify and initiate care for at-risk patients presenting to the ED.

1) Conduct surveys. Short surveys, though simple in approach, are an effective way for EDs to identify at-risk patients. For example:

The ED at the University of Michigan Medical Center instructs patients — following an initial screening process to determine eligibility — to complete a five-question electronic survey to screen them for eating disorders. This survey has proven successful in identifying patients who screen positive for a potential eating disorder and found many of these patients to be frequent users of their ED. Once identified, proper treatment can begin and lessen the likelihood of a return visit by these patients.

2) Create a risk assessment tool. Risk assessment tools built into existing electronic medical record systems are a great example of how existing technology can help identify at-risk patients. The Denver Health Medical Center ED uses such a tool to gauge a patient’s risk of HIV to determine whether or not they should be tested.

“The tool covers three demographic and five behavioral risk factors, each of which is assigned a point value, with the cumulative score reflecting the patient's overall estimated level of risk,” a report published by the Agency for Healthcare Research and Quality states. “A triage nurse administers the tool during the patient intake process and documents responses in an electronic tracking system that calculates the score in real time.”

And if the patient’s score suggests a moderate to high risk of HIV, then rapid HIV testing is conducted followed by counseling and links to ongoing treatment.

3) Develop a safety plan for patients. For those patients at risk of suicide, veterans especially, it’s important for EDs to have a suicide assessment strategy and intervention plan in place. Many VA hospital-based EDs have these plans in place, though it’s equally important for other EDs to consider. When veterans or other patients are identified to be at risk for suicide but don’t require an immediate intervention, a safety plan can be developed to help patients overcome their thoughts of suicide along with assistance connecting to community resources to lower the risk of suicide.

Do you have similar plans in place to identify at-risk patients and initiate the care? If so, comment below to share your experience or feel free to drop me a line.  

 

SOURCES: Agency for Healthcare Research and Quality: “Emergency Department Uses Tool To Identify At-Risk Patients in Need of HIV Testing, Leading to Same Number of Newly Diagnosed Patients with Fewer Screening Tests.”

Agency for Healthcare Research and Quality: “Emergency Department Screening Identifies Many Patients With Possible Eating Disorders, Suggesting Potential to Facilitate Earlier Diagnosis and Connection to Treatment.”

Agency for Healthcare Research and Quality: “Emergency Departments Identify and Support Veterans at Risk of Suicide, Enhancing Their Access to Outpatient Mental Health Services.”

How Real-Time Analytics Will Revolutionize Patient Flow in Emergency Departments

Nurse on iPad Donovan Partners

A new and important tool has emerged to greatly improve patient flow in the emergency department (ED) — real-time analytics. By analyzing real-time data to predict potential surges in patient volume, EDs are able to take a proactive approach to optimizing flow. As a result, EDs are able to quickly alleviate crowding and improve the overall quality of care patients receive.

Brent Newhouse, co-founder and head of customer success at analyticsMD, is helping hospitals across the country streamline operations by leveraging real-time analytics. The use of analytics in hospitals is growing, he says, and the results are very promising.

How it Works

Most hospitals live in a reactive world and aren’t using real-time data and computer-driven models. To many the idea may sound futuristic, a little mysterious, a little like Moneyball. But without predictive and prescriptive analytics, hospitals can react, at best, only after an issue has presented itself. Even worse, ED leaders may not know a problem existed until weeks later, after the monthly report is generated, says Newhouse.

In the world of real-time data, predictive and prescriptive analytics can help shape the choices ED leaders make to improve patient flow in real-time. Those working in the ED can follow all this data on a dashboard setup on a computer.

How to Ensure Positive Outcomes

Being able to predict and anticipate a problem is the first step. Taking action based on that prediction is the only way to ensure a positive outcome. With real-time, data-driven models, ED staff are now able to know exactly when patients arrive; how many are waiting and for how long; and where their patients are in the treatment process at the glance of a dashboard.

What’s the Difference Between Predictive and Prescriptive Analytics?

Predictive analytics approximates when a potential surge in patients may be expected based on incoming data; while prescriptive analytics uses this data to provide a recommended course of action, explains Newhouse.

Predictive programs, such as those offered by analyticsMD, are able to determine when patient surges will take place — something that is harder for someone who wasn’t a quantitative math or statistics major to figure out in a moment’s notice. What a huge benefit considering that when EDs become overcrowded, it’s often too late to do something about it. The use of real-time analytics allows EDs to nip problems in the bud and better anticipate and avoid bottlenecks related to surges in patient volume.

For the prescriptive part, these programs can also recommend generally what actions can be taken to alleviate or avoid the issue altogether, which decision-makers can then take into account when making the final decision.

However, in my experience in managing EDs, I should note that, as a rule, prescriptive analytics is not as fully of a developed technology as predictive analytics is at this time. It is just harder for a computer to make some of the judgment calls that an experienced human can. So it’s good to remember that these programs are not meant to replace human decision makers — the experienced health professionals all EDs depend on. Rather they are intended to be tools that vastly improve the information decision-makers have at their fingertips. It can help folks on the ground so they can make wise decisions more quickly — saving time and improving quality of care. That, in turn, makes for happier patients and maximized reimbursements.  

Real-Time Tracking of Resources

Another benefit data analytics can offer your ED is resource management info. If there are certain resources within an ED that are being underutilized, data programs can identify those resources, so decision-makers can put them back into rotation. Empty rooms provide a good example. Real-time analytics can show which room is empty, how long it’s been empty for, and make a recommendation about which waiting patient might make the most sense to treat in it.

The Future of Real-Time Analytics in Healthcare

With this much power, the use of real-time analytics is sure to gain wider prevalence as hospital leaders catch on to its benefits. Currently, it’s proving most helpful in providing hospital staff with information to help optimize patient flow processes, providing quick, high-impact results. In time, the use of real-time analytics will likely begin to influence decisions within other areas of patient care. For now, think of it as a tool that can be leveraged along with other strategies to optimize operations in your ED.

Meshing Data and People

I briefly touched on this important point earlier — collecting all of this beautiful data and then implementing change based on it are two different steps. But you don’t have to take just my word for it. As Venkat Mocherla, director of business development & marketing at analyticsMD mentioned in a recent blog, “ … to get the most out of big data, you need to be able to work with the people on the ground to bring informed change to life.”

Mocherla was inspired in part by Randy Bean in recent Harvard Business Review blog called, “Just Using Big Data Isn’t Enough Anymore.”

“The vast majority of the challenges companies struggle as they operationalize Big Data are related to people, not technology: issues like organizational alignment, business process and adoption, and change management. Companies must take the long view and recognize that businesses cannot successfully adopt Big Data without cultural change,” says Bean.

Keeping this in mind, if you are investing in big data, I advise that it is worthwhile to also invest in getting a plan together for implementing change based on your learnings. This is because I have seen this challenge crop up at hospitals I’ve worked with in the past.  

If your organization is working to leverage big data to improve operations, I’d love to help. I’ve helped more than one ED create actionable steps and coached staff through the process. I can leverage my 20-plus years of experience to help you optimize patient flow and show you how doing that can lead to increased quality of care and patient satisfaction. Drop me a line at

Even if it isn’t an opportunity for us to work together this important step of creating and implementing an action plan is not one to be missed. You want to maximize the investment you’ve made in data collection. It’s just smart business.

And if you’d like to learn more about how real-time analytics can give your decision makers on the ground information that has the potential to improve patient flow within your ED, visit analyticsMD.com.

3 Important Characteristics of Emergency Department Nurses and Why We Love Them

ImportantCharacteristicsofEmergencyDepartmentNurses

It’s easy to take emergency department nurses for granted. Even though they’re what I consider the eyes and ears of any busy ED, they don’t always receive the credit and appreciation they deserve.

Friday marked the beginning of National Nurses Week, reminding us to honor and celebrate these nurses who are so instrumental in providing safe, quality care in the ED. But what makes nurses so amazing? Here are just a few reasons to salute these hardworking women and men who are vital to a successful ED..

Uncommon Agility

You would be hard pressed to find any other profession where agility is so crucial to success. Being agile in an ED means always being on your toes, anticipating the needs of patients, their families and doctors. Agile nurses know what a patient or doctor needs before they themselves know they need it and the right questions to ask. Nurses in many ways have the keen ability to see in the future, which is vital when a life is on the line.

Superb Communication Skills

Anticipating the needs of patients, family members and doctors is one thing — being able to communicate with each of these very distinct groups is another.

First and foremost, great nurses are incredible listeners. They absorb directives from doctors that could easily be drowned out by the bustle of a busy ED. They also connect with patients and caregivers, listening to them in a way that help give the patient a voice in their care.

But listening is only half of communication. Nurses also have to speak with patients in a clear, concise way that’s easy to understand. One minute they may be talking to a 6-year-old boy with a broken arm, and the next, a 50-year-old man with an addiction to prescription painkillers. I can’t think of another profession where one communicates with so many different types of people, across so many demographics and socio-economic groups.

Enduring Empathy

Nurses care about the wellbeing of their patients — though they hope they never see them again, in the ED at least.

Empathy is the reason nurses are able to be considerate and sensitive when setting expectations regarding recovery. Empathy is also the reason why nurses return to work after a hard shift.

The strong sense of empathy that runs through each and every emergency department nurse isn’t always obvious, but we can rest assured it’s there — empathy is the reason nurses show up to work each and every day.

If the emergency department is the front door of a hospital, ED nurses are the ones making the very first impression and make sure that door is open to those who need it most.

One week really isn’t enough time to honor nurses and the important work they do, but National Nurses Week is a nice reminder for hospital leaders, doctors, patients and their families to show their appreciation for everything nurses do.

To learn more about what my company Donovan + Partners does, please check out our new website www.donovanpartners.com.

Wait Times: How Does Your ED stack up?

WaitTimes

Many patients might look at the emergency department (ED) like they would their neighborhood deli — first come, first serve. Luckily, for critically ill patients, this isn’t the case. The patients who need immediate treatment are going to receive it no matter how many patients are waiting.

Explaining this logic to a patient with a broken finger or a parent with a child experiencing cold symptoms may not be easy. The ED is the last place they want to be, and to them, their pain, or child’s pain, is a priority. Patients sometimes aren’t the best judge of their symptoms, and finding a way to get care outside of the ED can prove difficult depending on the day of the week, time of day and where they live.

The stats seem to reflect that. For example, from 2009 to 2010 more than 25 percent of all ED visits by children were for cold symptoms. For adults 12 percent of visits were deemed non-urgent, for cold symptoms and the like.

But it’s not just more non-urgent patients seeking care that are adding to wait times. With increasing numbers of patients visiting the ED for nonurgent conditions, wait times are bound to spike.

Year after year, average emergency department wait times have increased across the nation because visits are too. More people are seeking treatment at EDs — for urgent and nonurgent conditions — while the number of EDs is decreasing. According to the CDC the number of patient visits to EDs increased 32 percent over a 10-year period from 1999 to 2009. And at the same time many EDs closed their doors due to financial constraints.

So how does your ED’s average wait time compare?

One Measure: Broken Bones

The wait time for treatment of a broken bone is an important measure when it comes to hospital wait times. Of course, there’s different types of breaks and the severity of each will vary, but on average in 2014, a patient had to wait 54 minutes before receiving pain medications upon arrival in the ED.

For a national average, 54 minutes is long and depending on where a patient lives and which hospital they choose for treatment, the wait could have been much longer.

Take Washington, D.C. for example. Emergency departments in urban areas typically have longer wait times. In D.C., patients suffering from a broken bone had to wait an average of 69 minutes before receiving pain meds. This is only 15 minutes more than the national average, but with eight hospitals in the area the wait times varied drastically. If a patient sought treatment for a broken bone in D.C., they may have waited as little as 50 minutes for pain meds, or as long as 150 minutes depending on which ED they chose.

Difference in Wait Times Correlated to Patient Demographics

So who is facing longer wait times besides the no-critical patient? It seems adults go last and the old and the young are put first. According to the Centers for Disease Control and Prevention, Older patients, age 65 and older had the lowest mean ED wait time from 2008-2010 at 48 minutes. Children’s was 51 minutes And, adults 18 to 64 tended to have to wait the longest at 58 minutes.

Researchers found a difference when it comes to gender. Females experienced longer waits than males — four minutes more than men (57 minutes and 53 minutes, respectively).

There were even interesting stats around race. Non-Hispanic black patients experienced the longest wait times (68 minutes), while Hispanic patients waited 60 minutes, and non-Hispanic white patients waited 50 minutes.

What Will the Future Hold When it Comes to Wait Times?

On average they’ll increase, but there’s no reason your ED can’t be an outlier. First, you need to know where you stack up, which you can do by checking outProPublica’s ER Wait Watcher.

If you find that your patients are waiting longer than those at a nearby hospital, Donovan and Partners can assess your ED and uncover the reasons why. We’ll examine your triage process, staffing and patient flow, and then help you implement the best solutions to cut wait times. Contact us today at cmd@constancedonovan.com or 651-260-9918.

 

Sources:
ProPublica: “ER Wait Watcher, Which Emergency Room Will See You Fastest?”

Centers for Disease Control and Prevention: “Wait Time for Treatment in Hospital Emergency Departments: 2009.”

Centers for Disease Control and Prevention: “Health, United States, 2012, With Special Feature on Emergency Care.”

American College of Emergency Physicians: “Emergency Department Wait Times, Crowding and Access Fact Sheet.”