Among the many Affordable Care Act initiatives rumbling through the healthcare industry, the introduction of 30 to 40 million new patients is certain to create additional stress to an already overburdened healthcare system. As a result, hospitals must find ways to increase their patient throughput and operational efficiency. Unfortunately, inefficient inpatient discharge practices continue to create unnecessarily long hospital stays.
Patient throughput in the ED impacts the rest of the hospital system. ED lengths of stay generally increase when hospital occupancy levels exceed 90%, so enhanced communication and patient throughput are vital throughout the acute care setting. Although many factors can hinder patient flow, nearly 70% of clinicians cite communication as the most challenging cause of patient throughput delays.
EDs: The Communication Ground Zero
Communication in the ED sets the course for patient flow throughout the hospital. Safe, efficient, quality care in the ED requires frequent and effective communication. Nearly half of EDs report operating at or above capacity, and wait times and patient visits have risen steadily for the last 20 years. Initial communication with ED patients must be a top priority. As soon as patients register at the ED, they must be clearly informed of their anticipated treatment. Early communication about details, such as estimated wait times, anticipated discharge times, and availability of immediate treatments for minor symptoms, can smooth transitions of care.
Intricacies are sometimes forgotten but have a tremendous impact on patient throughput. The physical design of individual patient rooms can greatly affect throughput. When rooms are well-designed and provide optimum flexibility, patients can receive faster, more efficient care. In order to save space for high-acuity patients who require such accommodations, ED facilities should consider keeping low-acuity patients upright rather than on gurneys or in beds.
Boosting ED Communication
Several strategies can help boost ED communication, including the use of physician-nurse huddles, which take place at a defined moment in patient care. Setting trigger systems to alert nurses and physicians around specific physiology parameters can also be helpful, as is using a discharge timeout. During these timeouts, all patient information is reviewed by physicians and nurses prior to discharge. Reconciliation of abnormal vital signs is another effective approach to enhancing ED communication.
In addition, leveraging technology is vital to improving ED operations, patient flow, and communication. Examples include electronic information systems, electronic medical records, tracking systems, and hands-free communication. These tools can help patients better understand their plan of care and treatments and ensure that they receive timely updates about test results. Once factors for slowed patient flow are identified, hospitals can then take the necessary steps to address them. Hospitals that take action to improve patient flow and care transitions are likely to see improvements in patient health and outcomes while saving healthcare dollars.
Readings & Resources (click to view)
McHugh M, Van Dyke K, McClelland M, Moss D. Improving patient flow and reducing emergency department crowding: a guide for hospitals. AHRQ. 2011. Available at: http://www.ahrq.gov/qual/ptflow/ptflowguide.pdf.
Wilson M, Nguyen, K. Bursting at the seams: improving patient flow to help America’s emergency departments. Urgentmatters.org. 2004. Available at: http://urgentmatters.org/media/file/reports_UM_WhitePaper_BurstingAtTheSeams.pdf.
AHA Solutions. The 2012 patient flow challenges assessment: solutions and hospitals in pursuit of excellence. 2012. Available at: http://www.aha-solutions.org/what/pfca.shtml.
Fairbanks RJ, Bisantz AM, Sunm M. Emergency department communication links and patterns.Ann Emerg Med. 2007;50:396-406.
Institute for Healthcare Improvement. Optimizing patient flow: moving patients smoothly through acute care settings. IHI Innovation Series white paper. Boston, MA. 2003. Available at: http://www.ihi.org/knowledge/Pages/IHIWhitePapers/OptimizingPatientFlowMovingPatientsSmoothlyThroughAcuteCareSettings.aspx.
CRICO. Strategies boost ED Communication. September 1, 2011. Available at: http://www.rmf.harvard.edu/About-CRICO/Media/In-the-News/News/2011/September/Strategies-boost-ED-communication.
Institute for Healthcare Improvement. How-to guide: improving transitions from the hospital to home health care to reduce avoidable rehospitalizations. Cambridge, MA. 2012. Available at http://www.ihi.org/knowledge/Pages/Tools/HowtoGuideImprovingTransitionsfromHospitaltoHomeHealthCareReduceAvoidableHospitalizations.aspx.