Healthcare providers face a range of increasingly complex issues: rising costs, declining reimbursement, new technologies, the transition from volume to value, alternative payment methods, care transitions, and much more.
According to a white paper from Schumacher Clinical Partners’ Enterprise Chief Medical Officer, Randy Pilgrim, MD, FACEP — Aligning Your Emergency Department with Your Hospital's Priorities — EDs can play a crucial role in managing these issues, driving value, and enabling your hospital to thrive in spite of the chaotic healthcare environment.
"When aligned with the hospital's priorities, [the ED] can be a powerful, central hub for improving efficiency, reducing waste, and improving outcomes," Dr. Pilgrim asserts.
How do hospitals turn the emergency department into a strategic asset? It all begins with "right-sizing" says Dr. Pilgrim. In the white paper, he outlines a three-step process that begins with the ED itself.
1. Right-sizing the ED: Optimizing ED Foundations and Fundamentals
"A shaky foundation threatens all that is built upon it," Dr. Pilgrim says. "Before refinements or new processes can be implemented, it’s critical to work with your ED director and management to identify weakness in your foundation. Innovation is important, but not before your fundamentals are solid.”
The ED's foundations include: safety-net care, quality care for the acute treatment of sick and injured patients, rapid diagnosis, direction and coordination with EMS services, and disaster preparedness and response.
Other fundamentals to examine and optimize include: space and equipment, staffing for providers and support teams, effective leadership, and efficient treatment of time-sensitive conditions.
"Once your fundamentals are solid, you are on firm footing and ready to move forward and enhance your ED’s functions," Dr. Pilgrim says.
2. Right-sizing Key Interfaces: Innovative Opportunities to Leverage Your ED
"Delivering on your ED’s baseline responsibilities...shouldn’t be minimized, but it doesn’t represent the full spectrum of value your ED can deliver in an evolving environment," Dr. Pilgrim explains, "The real opportunities include using the ED as an initiator for care transitions, while enhancing the ED’s role with the large number of patients with intermediate and complex chronic conditions seen in emergency departments."
Two areas worth examination include:
Admissions. Typically, more than half of all hospital admissions come through the ED. Many ED patients have intermediate acuity and complex, chronic conditions, and there are opportunities to enhance the ED’s value with these populations.
"Essentially, your ED can function as a host for a very brief, 'mini-hospitalization,' allowing for additional diagnostic time and more targeted treatments,” Dr. Pilgrim stresses, “which ultimately shortens a hospital stay by enhancing diagnostic specificity and allowing earlier initiation of treatment."
Near-admissions. Hospitals and EDs face overcrowding and mounting healthcare challenges as ED visits increase and availability of inpatient hospital beds simultaneously decrease.
How can a hospital handle this challenge? The solution lies not in avoiding appropriate inpatient admissions, but addressing patients who require an inpatient stay of 24 hours or less.
"For moderately complex patients and/or patients with chronic conditions, the ED can be part of the solution," Dr. Pilgrim states in the white paper. "With adequate monitoring, testing, and treatment time in the ED, the needs of these patients could be accommodated and a hospitalization avoided. Of course, this requires agreement and alignment with hospital leadership on staffing, space, and adjustment of throughput expectations. However, there is significant value that can be delivered if all parties are aligned.”
3. Right-sizing Patient Care After the ED Encounter: Improve Post-discharge Care Transitions
With the introduction and refinement of inpatient criteria, many patients who were routinely hospitalized several years ago are now being discharged home to care for themselves.
However, the practice of sending “sick” patients home has outpaced the development of systems to support them outside the hospital. Chronically ill patients often do not get better at home and return to the ED. In some cases, their condition worsens to the point that they require hospitalization — an undesirable outcome for all concerned: the patient, provider, hospital, and payor alike.
"As a hospital leader, you can reduce healthcare costs and improve the patient’s overall experience of care by facilitating expedited access to home health services or other post-acute settings," Dr. Pilgrim says. Implementing a post-acute care discharge strategy will help your facility thrive in the shift from 'volume' to 'value,' helping you participate in advanced payment systems that reward care coordination and superior outcomes.”
He adds that employing a post-acute care discharge strategy involves providing an in-ED home health assessment for high-risk patients who are being discharged to home.
"Typically these patients do not meet criteria for an inpatient admission but may be too sick to recover safely at home without home-based support and resources," he says.
Patients view the emergency department as a trusted resource when they are sick and injured. Because of this relationship, the ED is in a unique position to extend its ability to impact patients beyond the four walls of the hospital. This benefits the patient in a number of ways: improved outcomes, quality of care, and increased patient safety and satisfaction.
For the hospital, there is significant, often unrecognized potential to generate financial, quality, and strategic value using the ED as a foundation, while also expanding its reach.
"To align your ED with your hospital priorities, you must be clear on what those priorities are, and constantly consider how the ED can help you achieve them," Dr. Pilgrim says.
He adds that to succeed, hospitals must consider how to ensure the ED has the fundamental resources it needs — “great leadership and an engaged team with the ability, capacity, and strategic thinking to help you address your goals."
To learn more about how to make your hospital's ED a value-driven asset, download Dr. Pilgrim's white paper: Aligning Your Emergency Department with Your Hospital's Priorities.