ED Overcrowding Not Emergency Department's Fault

The May issue of HealthLeaders Magazine features a timely and interesting article entitled, How to Get a Handle on ED Overcrowding.

In it, Deborah Kaczynski, MS, of University of Pittsburgh Medical (UPMC), a 20-hospital system in western Pennsylvania and a perennial member of the U.S. News and World Report honor roll of best U.S. hospitals, discusses ED overcrowding as a hospital-wide problem. Kaczynski, who works on the system’s patient flow initiatives and is a faculty member for the independent, non-profit Institute for Healthcare Improvement, emphasizes that improving patient flow means addressing the needs of other hospital units – from surgery to housekeeping – that are impacted by what happens in the emergency department.

“We had tried many of the traditional approaches in the past to improve patient flow and were very frustrated,” Kaczynski said. “Nothing was working. Ultimately, we learned that you couldn’t attack patient flow in a silo, as a single entity. You had to find a certain platform that would manage flow at the entire hospital level.”

She was joined in that observation by Kathleen Mikos, chief nursing officer and vice president for patient care services at Ingalls Memorial Hospital in Harvey, Ill., who oversees patient flow in the ED. “You are never going to make headway toward improving the ED unless you realize it’s a system issue,” Mikos told HealthLeaders. “We don’t want long wait times, so we have to be in a constant state of readiness.”

Much in the way plane flights stack up over large airports waiting for an open gate, new ED patients are left waiting while patients admitted from the ED are cleared for admission. This can lead to patient elopement, ambulance diversion, ED boarding and even poorer care. And, if the industry predictions are right, it probably will get worse, at least in terms of ED volume. According to the May HealthLeaders Media Intelligence Report, healthcare leaders “overwhelmingly expect an increase in ED volume within the next three years,” most likely due to provisions of the Affordable Care Act which may result in 30-40 million Americans with new health insurance.

Handling those patients will be additionally important because patient satisfaction scores will be part of the federal government’s reimbursement formula. Also, in many hospitals, the emergency department accounts for 60% to 80% of admissions.

UPMC’s Kaczynski uses a “real time/demand/capacity program” which helps staff predict bed demands each day and provides bed capacity status hospital-wide throughout the day. For example, the UPMC Shadyside campus six years ago, had ED lengths of stay that hovered “in the 400-minute” range. By 2013, the ED length of stay generally decreased “down to 230 or 240 minutes,” he adds. A key reason for the improvement was the real-time demand/capacity management program.

Ingalls Memorial’ Mikos says it took three hours to find a bed several years ago, but implementing an electronic bed request system has significantly improved the hospital’s ability to coordinate care, especially for patients transferred from the ED.

The article, written by senior editor Joe Cantlupe of HealthLeaders Online, goes on to make the point that more hospitals are turning to workflow management technology to reduce those waits, especially automated patient flow solutions.

We couldn’t have said it better ourselves! By intensely focusing on the hospital mission, TeleTracking solutions help hospital leaders manage patient flow as a continuum to be continually analyzed, rather than random individual actions. As a result, we’ve grown from a single bed management application to an entire suite of hospital patient flow solutions that address virtually every point identified along the continuum – from patient throughput, asset management / optimization, patient and staff tracking and inter-hospital patient transfers to process planning and patient flow redesign through our consulting division, Avanti, and real-time asset and patient tracking through our RTLS division.