1 June 2015

Strengthening Emergency Department Intake Processes

There are many measures of hospital quality, but two primary dimensions that stand out are patient health outcomes and operational efficiency. Though sometimes they seem to be at odds, the best hospital process improvements tackle these dimensions simultaneously.

Emergency department personnel are uniquely positioned to understand the relationship between patient care and efficiency — they treat both high acuity and high volume patient segments, and they’re largely measured by door-to-provider time and throughput. In the emergency department, improvements to intake and triage systems can have positive impacts on both patient outcomes and the operational efficiency of the department.

Example: Parallel Care Model of Patient Assessment

Slow door-to-provider times are a strong indicator of inefficiency in the ER — and a patient safety risk. Employing Kaizen lean process techniques, Dr. Ken Colaric of Sheridan partner hospital Saint Mary’s Medical Center in Missouri worked with his team to identify areas of inefficiency in their existing triage system. The Kaizen analysis and conversations with all stakeholders resulted in an entirely new “parallel care” model of patient assessment.

The parallel care model encourages emergency department personnel to attend to a patient as soon as they are available, rather than having providers wait for their proper turn in the traditional sequence of emergency care. The department also instituted immediate bedding, so that the patient is ready for a nurse, physician or tech to begin their work as soon as they are available to do so. Registration happens bedside, dramatically cutting down waiting room time.

Saint Mary’s new parallel care model and bedside registration have improved nearly every metric of success for the department. Patients’ average length of stay has been reduced by 30 percent. The “left before being seen” rate dropped a dramatic 88 percent. Door-to-bed and door-to-doctor times have seen significant decreases as well.

In many hospitals, 60-80 percent of inpatient admissions are made in the ER. With the majority of a hospital’s patients experiencing emergency care — and with CMS reimbursement now tied to patient satisfaction — the ER experience has never been more important. Identifying emergency department process improvements that benefit patients’ health outcomes, throughput and, by extension, patient satisfaction, is how hospital leaders can best drive lasting change in their ER.

To learn more about the ways Sheridan Healthcare can help strengthen your emergency department’s processes, read our leadership brief: “The Evolving Emergency Department: Strategies for Staying Ahead of the Curve.”