Best Practices to Drive Dramatic Improvements in ED Middle Flow
A recent article published in "Advanced Emergency Nursing Journal" examines the application and effectiveness of three practical tools for improving the efficiency of middle flow (examination to disposition time) in Emergency Departments. The article is by Angie Esbenshade, RN, MSN, MBA, an ED expert coach in Studer Group's Emergency Services Division with an extensive track record helping EDs achieve dramatic turnarounds in flow, length of stay (LOS) and patient satisfaction.
ED flow can be assessed in three broad categories: Front-end flow (door to provider) is typically improved through measures such as efficient triage and immediate bedding that reduce wait times for faster patient care (Baker, Shupe & Smith, 2013). Back-end flow (disposition to discharge or admission) must be addressed through hospital-wide collaboration. Middle flow, the focus of Esbenshade's article, presents key opportunities for rapid, sustainable improvement that can be driven by ED nursing leadership. Here are the three key tools:
- Operationalizing a Results Pending (RP) Area: Low-acuity patients who are awaiting diagnostic results or who require further observation can be moved into a dedicated RP space within the ED where they are monitored by a dedicated nurse. ED rooms and beds are reserved for higher acuity patients and bed turnover is accelerated. RP best practices include a range of tactics for scaling the RP space, identifying appropriate patients, and optimizing RP utilization.
- Monthly Operational Stakeholder Meetings: Monthly meetings involving all members of the ED team are used to monitor flow, solve problems and identify necessary improvements. Attendance should include nurse and physician leaders, frontline ED staff, key staff physicians, and ancillary and support leaders in areas such as registration, laboratory services, IT and security. As these meetings become part of the ED routine they typically last no more than one hour but provide critical opportunities for all stakeholders to align around common goals, with shared performance metrics and targets.
- Internal Customer Rounding: The internal customer rounding process is the structured follow-up to the monthly operational stakeholder meetings. Rounding involves scheduled one-on-one meetings between the ED leader and various key members of the ED team, including the ancillary leader and department heads. Frequency is determined at the monthly meetings and can vary with current priorities and challenges. These brief, typically 15-minute rounding sessions build collaboration while hardwiring a consistent focus on priority goals.
See "Making the Middle Count: Three Tools to Improve Throughput for a Better Patient Experience" by Angie Esbenshade for a full discussion of these three flow improvement tools, including tactics for best- practice implementation and results from high performing Emergency Departments.
If you are interested in an ED Assessment, contact Bonnie Cochrane at Bonnie.Cochrane@studergroup.com.