New Patient Flow Strategies? What to Keep in Mind for Implementation

Improving the patient flow process in your emergency department relies heavily on not only what strategies and solutions you choose to implement but also how you decide to implement them.

A strong correlation exists between efficacy and execution. A detailed patient flow implementation plan acknowledges potential challenges and barriers, includes a detailed timeline and offers flexibility. By having one in place, you’ll increase your odds of success.

While your new patient flow process — and the strategies and solutions you’ve decided upon to create it — may seem foolproof on paper, below are  a few things you should consider before, during and following implementation.

Start slow. 

Improving patient flow isn’t a sprint; it’s a marathon. Expect to tweak your plan and strategy during the implementation process and adjust accordingly. Also, give a strategy or solution time to take effect. Like the medication prescribed to patients, relief isn’t always immediate. It takes time, and significant impact may arrive only after another component of the plan has been enacted.  

Create a communication plan. 

Ensuring your plan’s success will be a team effort. From hospital administrators to ED support staff, getting their buy-in will be critical and will require effective communication between stakeholders. Before launch, develop a communication plan with your patient flow team that will enable you and your team to troubleshoot any issues or concerns as they arise and to make sure everyone is on the same page.

Whether you schedule a daily in-person huddle, weekly Skype session, conference call, email thread or group chat, make sure the lines of communication are open and that all of your team members have an opportunity to share their voice as you implement your plan.   

Be realistic. 

This may be the most important thought to consider when implementing new patient flow strategies. To effect change in the ED, you have to take into account what your resources are and how they will determine your results.

For example:

• Figure out early on whether or not you have the budget to implement new strategies. You must also determine if the results of implementation will provide a positive return on investment for both your bottom line and the quality of care your ED delivers to patients.
• Consider personnel resources. If your patient flow plan consists of developing or adding a new position — think patient flow navigator — do you have the money to make it happen? If not, will you be able to secure more funds? How long will it take? Also, determine whether or not your plan will require staff to learn new skills.     

Take time to reflect. 

When you carefully consider each component or strategy you plan to implement it will prepare you for any hiccups along the way. It can give you time to create buy-in among your teammates and opens the lines of communication between one another. Devoting ample time for pre-launch review and dialogue among staff will make improving patient flow that much easier.

What else should one consider when working to improve patient flow within the emergency department? Share your comments below or feel free to drop me a line with your experience.

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

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

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.”

A Case Study: How to Improve Patient Flow

I recently came across this case study on how one hospital undertook system wide improvements and small “tests of change” in an effort to improve their patient throughput.

I like this idea because it helps show that undertaking small changes using “innovation and creativity instead of capital,” as the hospital wrote, can yield improvement in key metrics.

Carondelet St. Mary’s Hospital in Tucson, Ariz. was looking to lower the number of patients who left without treatment 34 percent to 2.89 percent and reduce the length of stay for admitted patients from 8.85 hours to less than 5 hours — an improvement of 74 percent.

Spoiler: They did it! How you ask?

Here were the tactics they tried:

• They worked on better predicting capacity and demand. Inpatient units worked on identifying patients who were a high potential for discharge from the ED the following day and these were communicated via an electronic bed tracker.

• They worked on stepping up their communications game. Rather than just relying on one communications handoff they incorporated more regular reporting in a variety of formats including: electronic daily reports, weekly reports, and month comparisons year over year.

• They assigned nursing staff very specific, specialized roles. One became specifically responsible for triage, another for rapidly placing patients in Emergency Center (EC) beds, and another focusing on discharge and transfers in the patient flow process. Allowing nurses to specialize on one task, for example, getting a patient through a certain area of the emergency department in a specified number minutes helped them stay focused on their work rather than having to wear many hats and clarified areas of responsibility.

• They weren’t afraid to bring in a triage nurse practitioner during peak times. Triage NPs were initiating medical screening exams with medical orders so they could reduce “wasted wait” time and initiate treatment more timely.

• By adopting new real-time technology — EC using Dracker and Teletracker interface — to request beds for inpatients they were also able save time.

 Have you tried similar “tests of change” in your emergency department and had success?

If you’d like help in evaluating where you might be able to try some changes to produce results, contact me. I’m happy to help evaluate your emergency department and get you started on a path to being more efficient.