Part three of our series on ED efficiencies featured on Becker’s Hospital Review. Part one dealt with patient arrivals; part two addressed how to improve efficiency related to the in-room patient work-up. This post concludes the series by focusing on the three drivers of efficiency for the disposition of ED patients.

In his article written for Becker‘s Hospital Review -- Clinical efficiency tricks for the emergency department: Disposition -- Dr. Kenneth J. Heinrich, regional director with Schumacher Clinical Partners, lists three drivers of efficiency related to the disposition of patients from the ED: creating a culture of urgency, determining the availability of hospital beds, and fostering a partnership between the ED and hospitalists.

Creating a Culture of Urgency

"Traditionally, ED physicians would see patients and then decide when those patients were ready to be discharged," says Dr. Heinrich in the article. "They would fill out discharge instructions and prescriptions, put it on the chart, and walk away. After that, the nurse took over...At some point after the physician's discharge decision and according to the nurse's timetable, the patient would actually leave the ED."

He cites three process gaps that contribute to inefficiency: the time from physician to nurse, nurse to patient, and then patient to the door. This lack of efficiency can foster several episodes of needless waiting, which leaves a negative impression in the patient's mind about the entire patient experience.

The "trick," according to Dr. Heinrich, is to loosen up roles and get people to rally around the disposition process.

"Nurses and providers should be equally, and cooperatively, engaged in the discharge process and should have the flexibility to function as a team," he says.

Lack of Available Beds

Dr. Heinrich says a key solution to the lack of available beds is to create a "bed czar" -- someone responsible for finding and assigning open beds quickly.

He recommends that staying ahead of the needs of the ED regarding beds should be the sole or, at least, the main responsibility of the czar, preventing last-minute scurrying to find a bed, getting it cleaned, and locating a nurse to take the patient to it.

"[T]he bed czar estimates how many beds will be needed each day based on prior averages and can get a sense of open beds when starting his or her shift," Dr. Heinrich says. "By staying in close contact with the ED, this person can keep an ongoing list of probable admissions and [the] approximate timing of those admissions."

Partnership Between ED and Hospitalists

Another issue Dr. Heinrich addresses in the article regards the need to foster a meaningful partnership between the ED physicians and hospitalists, to increase efficiency in the hospital admission process.

"Hospitalists and the ED need to work together to ensure most hospitalist evaluations and full-admission orders are performed on the floor, where the patient is most comfortable," he says, adding that, together, ED physicians and hospitalists must develop standard protocols and approaches to hospital admissions from the emergency department.

"Like any efficiency effort, you need both individual buy-in and systemic change to make lasting, sustainable improvement," he says.

Visit the Beckers Hospital Review website to read the article in its entirety. To access the previous two posts in the series, see below: