Today’s patients spend an average of two hours in the typical emergency department, says the Centers for Disease Control and Prevention, and low acuity patient wait times can be even longer.
Solving the problem is not easy, but the goal of maintaining quality and throughput, while reducing wait times and improving patient satisfaction, is worth the effort.
Here are five ways to achieve it.
1. Know Your Numbers
Evaluating the right metrics can help identify critical areas of improvement, including performance, patient flows, where time is being spent, and how different strategies work.
For example, SCP Health collaborated with a 383-bed hospital in New York that was experiencing an average annual ED volume of 78,000 and consistently held an in-house census of more than 400 patients.
The metrics revealed the facility faced high ED hold time, high door-to-doctor times, high LOS times, and 418 diversion hours in a single calendar year. Not surprisingly, it experienced low patient satisfaction scores as a result.
Working alongside the hospital, SCP Health implemented a Rapid Assessment Zone, a new treatment area separate from the Emergency Department for low and moderately acute patients.
Within the first year, the hospital was able to drastically improve quality and throughput metrics while encountering a 10 percent increase in volume.
The result by the numbers:
- Door-to-arrival times dropped from 11.7 minutes to 7.7;
- Door-to-provider times went from 17 minutes to 11.6 minutes;
- Discharge LOS time was reduced by 16 minutes, from 190 to 174;
- Door-to-EKG fell more than 10 minutes, from 17.7 to 6.9;
- Diversion hours showed a dramatic decrease, from 418 hours to four hours.
As you can see from this example, knowing your numbers provides a baseline from which to improve.
Related resource: ED Flow: In-room Strategies to Improve Throughput
2. Right-size the ED
Right-sizing your ED can also reduce the steps needed to complete tasks and create a more efficient environment. This includes addressing the fundamentals of space, equipment, and provider staffing. It also means introducing strategies for ensuring higher levels of patient engagement, better outcomes, and lower costs.
Some right-sizing tactics in use include:
- ED observation, short-stay units, or rapid treatment units that bridge the gap between an ED visit and hospitalization;
- Rapid diagnostic units designed to optimize diagnostic specificity and improve risk stratification;
- Case management and patient navigator programs after patients are discharged.
These approaches require time, resources, space, and organizational commitment to implement, but such cost-efficient alternatives that leverage emergency care in new ways have merit and show considerable promise.
3. Add NPs and PAs to the Clinical Team
Pairing up physicians with nurse practitioners and physician assistants can alleviate stress in the ED.
NPs and PAs can assist doctors in a triage capacity, quickly assessing and identifying patients with higher acuity, sending them for examination by a physician, while treating lower-acuity patients themselves. The result is a reduction in wait times and more efficient patient care.
As a case in point, in 2017, SCP Health (SCP) partnered with Jackson North Medical Center, North Miami Beach, Florida, to implement a "provider-in-triage" process to reduce door-to-doctor times.
In this model, the facility located an NP or PA near each of two triage rooms where they conducted a brief screening and SOrT process. Higher acuity patients were then sent directly to a bed and ordered the appropriate diagnostic studies.
This approach resulted in a reduction in door-to-doctor time by almost 93 percent, from 125 minutes to nine.
4. Incorporate Telemedicine
Telemedicine (or telehealth/eHealth) is often associated with hospital medicine. However, many EDs are incorporating telemedicine as well.
One New York hospital that consistently suffered from long wait times began utilizing it with lower acuity patients, according to an article from Definitive Healthcare, a healthcare industry information services provider.
"If a patient is deemed to be in stable condition, they are eligible for the hospital’s express service," the article said. "Express patients are then sent to their own room where they have a video conference with affiliated physicians in other areas of the … health system.”
Since launching the express telemedicine program, wait times have plummeted from 150 minutes to 18 minutes, the article said.
5. Manage Patient Perceptions
When it comes to patient experience within the ED, perception is everything. One of the best ways to change the perception from negative to positive is by communicating more effectively, both verbally and non-verbally. That means getting rid of "doctor speak," sharing wait time information (and apologizing for long wait times when necessary), showing compassion and empathy, and asking the patient for feedback.
According to Patient Experience Journal, a peer-reviewed medical journal, patients who received wait time information were significantly more satisfied. Patients were also more likely to accept longer wait times provided their expectations were managed via communication.
Related resource: 10 Easy Ways to Improve Patient Satisfaction in the ED
Regardless of which approach you take, it's vital that you view the wait time reduction holistically, not piecemeal. That requires a combination of good leadership, effective communication, consistent teamwork, efficient check-in and discharge procedures, smart hiring, and improved patient perception.
You can't do everything at once, however. Instead, you need a detailed, step-by-step plan for how to involve the right people and foster the most favorable change.
That's where our management solutions comes in. Every day, our experienced team helps facilities like yours achieve their long-term objectives. That includes everything from strategic planning to clinical operations performance to revenue cycle transformation and more.
Don’t keep your patients waiting! Contact us today to learn how SCP Health management solutions can benefit your organization.