7 March 2016

Care Strategies For Clearing ED Bottlenecks

Stakeholders from policymakers to providers agree that a “right care, right place, right time” strategy is the optimal approach to delivering consistent, value-based care. But turning that philosophy into an actionable strategy is a significant new challenge that involves complex internal and external logistics as well as patient cooperation.

Determining the best ways to dramatically improve population health and patient care while maximizing resource utilization efficiency is a daunting proposition. An estimated 60-80 percent of inpatient admissions in many hospitals are made in the ED, so identifying and removing ED bottlenecks and improving the efficiency of ED resource utilization are essential components of any value-based care delivery strategy.

According to HealthLeaders Media’s report “THE EXCEPTIONAL ED: Telemedicine, Navigation, & Behavioral Health,” 69 percent of survey respondents cited ED-to-inpatient transfers and 38 percent cited the lack of an alternative stream for low acuity patients as top bottlenecks to ED flow.

Two strategies worth considering to address these issues are:

1) Using holistic, collaborative, lean process improvement methodologies such as Kaizen to identify and minimize emergency room bottlenecks and reduce wait time for ED-to-inpatient transfers.

2) Forging partnerships with leading retail pharmacy chains to streamline coordination of appropriate care delivery and diverting patients to the most cost- and time-efficient provider.

Using Kaizen to Identify and Clear Bottlenecks in the ED

Kaizen is a lean methodology for institutionalizing continuous business process improvement. When applied to health care, this practice facilitates significant efficiency and care quality improvements, boosts patient satisfaction, and increases job satisfaction for physicians and other hospital staff. Kaizen is an integral part of Sheridan’s successful model for delivering value-based care that has proven effective at reducing waste, lead times, cycle times and hand-offs in our hospital EDs. Getting your clinical leaders, nursing staff and other team members – including the C-suite – to collaboratively develop solutions to ED bottlenecks in a Kaizen event is one of the best ways to discover and implement potential improvements.

Partnering With Retail Pharmacies to Reduce Waste

An emerging model that may help address the lack of an alternative stream for low acuity patients involves partnerships between major health systems and large retail pharmacy chains. One of the best examples is Johns Hopkins Medicine and Walgreens, which have been collaborating since 2013. 

Their joint clinical and economic research are focused on a Baltimore-based pilot program aimed at creating scalable clinical pathways that can be effective on a national level. The pilot program will attempt to route patients to the most appropriate site for their condition, with an emphasis on moving patients who rely on the ED for primary care to more cost-effective and coordinated sites.

The Walgreens adjacent to the Johns Hopkins Medicine campus serves as both a drugstore and a training site. According an article in HealthLeaders Magazine, Jeanne M. Clark, M.D., director of Johns Hopkins’ division of general internal medicine and a professor of medicine at the medical school, says the collaboration will develop efficient best practices and educate the public, providers, and policymakers about ways to move some clinical care to lower-acuity sites.

One great example of routine, low-acuity care that can be easily diverted to a partner is rabies shots. In Maryland, the ED is currently the only place where the rabies vaccine is stocked and administered. The treatment involves multiple visits for follow-up injections after the initial evaluation and vaccination. Moving subsequent visits for the remaining shots from the ED to a retail pharmacy frees up ED resources for emergent care and provides more convenient and efficient care for the patient. In a Harvard Business Review article, CVS Health also makes a compelling case for health systems partnering with pharmacies. 

Learn about additional strategies for staying ahead of the curve in Sheridan’s leadership brief on The Evolving Emergency Department.