Part two of our three-part series on improving ED patient flow featured in Becker’s Hospital Review.
Many patients who have been admitted to the ED promptly, only to be marooned in a room waiting for lab test results or to be examined by a provider, will readily admit to a sense of uneasiness and distress.
Aside from the lack of efficiency brought on by tying up an emergency room bed, there is also an inherent danger relegating a patient in dire need of care to the waiting room.
In a recent article featured in Becker’s Hospital Review, “Clinical efficiency tricks for the emergency department: In-room,” Dr. Kenneth J. Heinrich, regional director with Schumacher Clinical Partners, says it does not have to be that way.
He outlines the primary strains on in-room efficiency in the emergency department and lays out some specific measures EDs can take to avoid them.
In the article, Dr. Heinrich says two of the common slowdowns in the in-room patient workup occur with lab testing and radiology.
"Radiology-related delays occur mostly when the ED physician must wait for imaging to be completed before he or she can prescribe an appropriate treatment," he said.
Of those, CT scans and ultrasounds are the chief culprits because they rely on interpretation by a radiologist, who might be unavailable or working on other patient's scans at the time.
Dr. Heinrich recommends that all hospitals should measure lab and radiology turnaround times, focusing on the most common tests performed in the ED, and do so from the patient‘s perspective.
"A patient who waits an hour for a test result would likely be irritated to hear the lab tout a turnaround time of 20 minutes even if, from the time the sample was recorded to the time the test is completed, only 20 minutes have passed," he said.
Another problem, according to Dr. Heinrich, relates to provider workflow.
"One of the main delays for in-room efficiency can be traced to the time before that decision is issued," he said. "There are very few EDs where you won't find patients occupying rooms unnecessarily, waiting for disposition."
His trick for improving efficiency: dispo first.
"With the obvious caveats about emergent patients, both workflow and bed space in the ED are more efficient when physicians work on getting stable patients out of the ED before they move to new patients," Dr. Heinrich said. "Physicians who accept this axiom can look to various strategies to help accomplish this goal."
The third drag on efficiency lies with systemic workflow issues -- an ED team that is not working as quickly as the information flow permits, for example.
"Issues like these, coupled with a renewed emphasis on disposition, can be addressed at an administrative level with the addition of a position dedicated to patient flow," Dr. Heinrich said.
His remedy: Bring in an "air traffic controller" to coordinate patient flow.
"A charge nurse is supposed to fill this need, but charge nurses in the typical ED are, in my experience, swamped," Dr. Heinrich said. "With a dedicated patient flow coordinator, though, busy EDs are better able to pinpoint and eliminate unnecessary delays."
Visit the Becker’s Hospital Review website to read the article in its entirety.
Also, stay tuned for part three of Dr. Heinrich’s expert tips from the Becker's series, “Clinical efficiencies for the emergency department: Disposition,” a synopsis of which we will make available here.