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| EDs Optimize Capacity and Throughput (continued) |
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To optimize capacity and throughput, hospital-based EDs may try these three options: |
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Acuity-based redirect. This somewhat controversial practice fosters more appropriate ED use. With this technique, the ED triages all patients and provides a medical screening exam as required by EMTALA standards. Then for patients with nonurgent conditions, it offers two options: pay upfront for care or seek care elsewhere. For those who choose to seek care elsewhere, the ED provides a list of community resources. |
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Proactive program for frequent users. In Nebraska, three EDs found that 34 patients made 377 ED visits, and that 12 of these patients accounted for over $200,000 in uncompensated care. By combining forces, the EDs developed a proactive plan for these frequent users.
First, they evaluated patients with three or more nonurgent ED visits in 6 months, noting their demographic and medical history data, risks, and barriers to existing primary care. Then they developed an individualized plan of care that included a patient contract to build accountability and methods to remove barriers to care.
Although the program was costly, the hospitals discovered it was worth the investment. ED visits by frequent users fell 69%, which reduced ED uncompensated charges—and capacity problems. The program also increased appropriate care for former frequent users. |
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ED toolkit. Surprisingly, expanding the ED is not always the best way to add capacity. For example, Vanderbilt University Medical Center expanded from 28 to 53 ED beds only to find little improvement in ambulance diversions, wait times to see a physician, and numbers of patients who left without being seen.
The Advisory Board Company, an independent consulting firm, suggests that efficiency metrics, such as annual visits per ED bed, should drive the expansion decision and offers several tools to aid in that decision. One tool, for instance, lets the hospital input annual volumes, average length of stay, and the current number of ED beds. The hospital can select different targets for length-of-stay reduction. Based on these targets, the tool calculates new throughput goals. This lets the hospital know if it can boost efficiency before investing in capacity. |
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For other ways to increase ED efficiency and optimize throughput, check out the online course Emergency Nursing Triage. For details, call 866-416-6697. |
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Source: The Advisory Board Company. The high performance ED: Optimizing capacity and throughput to meet ever-growing demand. 2008. The Advisory Board Company Web site. www.advisoryboardcompany.com. Accessed September 18, 2008.
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