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

Patient Safety: How to Improve the Patient Handoff Process

Patient exiting ambulance

The patient handoff process is one of the most critical moments for patient safety in an emergency department. When emergency medical services personnel arrive at your door with a patient, challenges will arise, and an appropriate response by Emergency Department staff is necessary for a successful handoff.

When it comes to an EMS-to-ED handoff the greatest challenges lie in communication. There’s an increased potential for miscommunication — or lack of communication — that can have dire consequences for the patient.

Researchers recently evaluated 90 patient handoffs, studies of which have been limited when it comes to components of quality care. Looking at communication between EMS personnel and ED staff during the handoff, researchers found that EMS personnel provided ED staff:

  • Information related to the patient’s chief concern 78 percent of the time;
  • A description of the scene in 58 percent of all handoffs;
  • A complete set of vital signs in 57 percent of instances;
  • A description of physical exam finding for 47 percent of patients;
  • An overall assessment of the patient’s clinical status in 31 percent of cases.

Researchers did note that handoffs between certified paramedics and ED staff resulted in higher instances of communication of vital signs and physical exam findings, and that paramedics offered an overall assessment more than twice as often than other levels of EMS staff such as EMTs.

This study confirms that there is significant room for improvement during the handoff process of critically ill and injured patients, researchers concluded.

So how can the process be improved in order to provide patients with the high quality of care they expect from EMS providers and ED staff?

Another study looking at this same topic found that EMS providers often saw themselves “as advocates for their patients during the challenging EMS-to-ED handoffs.” And they, in turn, offered four strategies for improving the handoff process, some of which address issues related to communication, while others addressed EMS and hospital protocols that make handoffs more challenging.

Tactics EMS providers suggested include:

  1. “Communicate directly with the ED provider responsible for the patient’s care.”
  2. “Increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers.”
  3. “Standardize some (but not all) aspects of the handoff.”
  4. “Harness technology to close gaps in information exchange.”

While these solutions offered by EMS providers have the potential to be effective ways to improve the handoff process between EMS and ED providers, buy-in would be necessary from the ED standpoint.

Do you think these solutions are reasonable? What can emerFgency departments do on their end to help facilitate a safe, high-quality handoff experience for patients? I’d love to hear your thoughts. Comment below or feel free to drop me a line.

Sources:

Prehospital Emergency Care: “Quantitative Analysis of the Content of EMS Handoff of Critically Ill and Injured Patients to the Emergency Department.”

Annals of Emergency Medicine: “Optimizing the patient handoff between emergency medical services and the emergency department.”