Posted June 17, 2016

Rethinking Emergency Department Results: Are You Treating Before Diagnosing?

By Karen Smith, MSN, RN, CEN, NE-BC

Would you ever start an antibiotic without having a diagnosed infection? How about having a cast applied before the X-ray is taken? We expect to be examined and a diagnosis made BEFORE starting any prescribed treatment. The same approach should be taken when identifying ways to improve Emergency Department (ED) results.

Have you ever wondered why your ED does not seem to have efficient processes? Do your goals for the department seem elusive and unattainable? Are you concerned that the engagement of your staff is not where you want it to be? The problem may be that you aren’t addressing the right problems, or you are trying to treat a problem before properly diagnosing.

With many ED volumes rising1, EDs and healthcare organizations must develop and implement the right tools and skills to drive results.

Our Studer Group Emergency Department experts use a diagnostic approach to determining the individual needs of an ED. This precedes the formulation of the treatment plan and consists of four key steps:

  1. Assess: The first step is to conduct a comprehensive assessment of the operational flow of the ED. This includes direct observation of patient movement, review of key operational metrics, staffing patterns to match patient volumes, overall productivity, and patient survey responses.
  2. Align goals: The next step is to determine goals for the ED and how those goals will be measured. The leaders must be in agreement of the vision for the department and setting goals that align with that vision. These are the building blocks for an objective evaluation system, such as Leader Evaluation Manager® that holds leaders accountable for achieving and exceeding their goals.
  3. Align behaviors: There are certain behaviors and tactics that drive results in the correct direction. Expecting ED staff to change patterns or habits can be hard. Careful sequencing of change implementation must be accompanied by a large dose of the ‘why’ or the evidence-based reason to change. Teams will not see the full results of these changes without ensuring each are hardwired (have become habits).
  4. Align processes: Using the observed patterns and existing ED flow metrics vs. known best practices will help teams to determine which flow models need to be implemented. Splitting the flow of patients and processing them based on their assessed acuity level will ensure that every patient receives excellent care in as timely a manner as possible.

Let’s look at an example: If an ED wants to assess and treat a higher-than-average rate of patients leaving without being seen, the four steps might look like this:

  1. Assess: Examine the reasons why the rate is elevated based on triage process flow from arrival to being seen by a provider. Key metrics may indicate prolonged door-to-provider intervals or longer-than-average lengths of stay. Analysis of staffing to match arrival patterns must be considered as well as the efficiency of key interdependent departments.
  2. Align goals: Setting goals for improvement might include reducing the overall percentage of patients leaving without being seen and also the return-on-investment resulting from captured revenue. Leaders can then formulate specific action plans to focus their attention on the goals.
  3. Align behaviors: Our approach and communication to patients as they wait to be evaluated by a provider will directly and positively affect their willingness to wait and their overall satisfaction.
  4. Aligned processes: Implementing best practices for expedited triage and direct bedding can reduce the time interval of arrival to being seen by a provider. Other process tactics to implement could include placing a provider in triage or use of a results pending model.

Remember to connect back to the ‘why’? Reducing left-without-being-seen (LWOBS) will improve patient safety and satisfaction, increase revenue, and reduce risk when patients leave without evaluation. Plus, it will save ED staff members’ valuable time.

The results of this approach are staggering. For example, in one organization coached by Studer Group, a decreased overall LWOBS resulted in an annual savings of $289,000. In another Studer Group partner organization with an ED volume of 120,000 patients, LWOBS rates decreased by more than 50 percent resulting in an ROI of $6.4M in increased annual revenue.

How much do your ED results matter? Use this ED financial benefit calculator to determine the value of improving your LWOBS and other ED metrics by as little as one percent.

High-performing EDs have mastered efficient patient flow using foundational behavioral goals and behaviors. As EDs are the front door to most hospitals, our patients deserve an evidence-based approach to their clinical care that is based on a diagnostic workup. Additionally, patient flow through the ED is also positively influenced by evidence-based processes that are part of a comprehensive treatment plan based on diagnosis.

ED providers and staff make a difference every day in the lives of patients and families. By putting these steps into place, the life you save may someday be your own!

Access additional complimentary resources for the emergency department or connect with an ED expert to discuss whether a specialized, intensive assessment is needed at your organization.

1 ER Visits Continue to Rise Since Implementation of Affordable Care Act. American College of Emergency Physicians, May 4, 2015. http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act

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  • Karen Smith

    Karen Smith, MSN, RN, CEN, NE-BC

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