Maximizing Emergency Department Patient Flow and Addressing Patient Satisfaction in Panel Discussion
Expert panelists discuss strategies for enhancing patient throughput and satisfaction in emergency departments, covering topics such as care on arrival, low-acuity patient redirection, front-end operational changes, and simulation modeling of ED operations. The discussion also delves into drivers affecting ED operations and quality, the healthcare environment's impact, service expectations, and quality indicators in emergency medicine.
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AACEM and AAAEM Panel Discussion Emergency Department Patient Flow Maximizing Patient Throughput and Addressing Patient Satisfaction J. Scheulen, Johns Hopkins L. Davis-Moon, Thomas Jefferson 9/23/2024 1
Patient Throughput Panel Discussants Travis Schmitz, Northwestern Care on Arrival Louis Burton, Grady Low acuity patient re-direction Adrian Tyndall, MD, Florida Front end operational changes James McCarty MD, Hermann Hospital Expedited MICU Admission Louis Burton, Grady Boarding---What s that???? Jim Scheulen, Johns Hopkins Simulation Modeling ED Operations Ted Christopher, MD, Thomas Jefferson Patient Satisfaction 9/23/2024 2
EMERGENCY DEPARTMENT PATIENT THROUGHPUT 9/23/2024 3
Emergency Medicine Drivers of Operations and Quality Volume Balanced = efficient operations 9/23/2024 4
Emergency Medicine Healthcare Environment Hospital Operating Paradigms Decreased National Capacity Late discharges Keep patients out Primary Care Physician Availability MD s are at capacity No after hours care Patient population Elderly and Complexity Insurance Underinsured EMTALA Hospital Capacity Beds reduced ---Demand increased Excess capacity was surge capacity 15% required for efficiency Volume
Emergency Medicine Service Expectations Drive thru if possible!!! 24 Hour Service Minimal Waiting Time Demand Based Service Different Expectations AND A Different Standard It s okay to wait days for my MD but not hours in ED Convenience and Episodic Care
Emergency Medicine Quality Patient Care Quality Measure Quality Indicator Wait time Throughput times Walkout Rate Service Time Communication Amount and Type of communication Satisfaction Surveys Compliance with practice standards STEMI Sepsis Pneumonia Trauma Adverse Events Clinical Quality Outcomes 7
Time is central to Emergency Medicine Quality = Time 9/23/2024 8
Emergency Medicine Quality Metrics Time Perception of Care Satisfaction Adverse Events Poor Outcomes Increased patient mortality Increased ambulance diversion Delays in time sensitive treatments Increased LWBS 9/23/2024 9
Emergency Medicine All about Process Segmenting Patient Flow in the ED Process Time Moderate Acuity Level 3 Med/Surg Dx and Rx Likely Discharge Complex medical Dx and Rx Possible Admission Main ED Clinical Decision Unit
Process, Process, Process Intake Throughput Output Clinical Time Door to Triage Door to MD Door to Bed Assessment Decision to Admit Decision to D/C Discharge to Home Admit to Hospital Admit Observation Front End Back End 9/23/2024 11
Emergency Medicine Discussion Background Volume 9/23/2024 12
Discussion and Questions Best Practices: Front, Middle, Back End Related Questions: What are the most important metrics to use in order to monitor success? As a way of managing excess volume, are there hospitals who successfully redirect patients to alternate treatment sites? Who in your system is responsible for the care of the patient who is boarding in the ED? Has anyone identified an effective way to manage physician practice variability? 9/23/2024 13
Process, Process, Process Clinical Time Door to Triage Door to MD Door to Bed Assessment Decision to Admit Decision to D/C Discharge to Home Admit to Hospital Admit Observation Front End Back End Louis Burton: Grady Diverting Low Acuity Pts Travis Schmitz: Northwestern Care on Arrival Adrian Tyndall, MD: Florida Front End Process James McCarty, MD: Hermann Expedited MICU Admission Louis Burton: Grady Boarding at Grady 9/23/2024 14
