Patient Flow Processes

The emergency department is often challenged by a series of complex patient flow processes. In many situations, these processes contain wasteful steps in the form of duplication, excessive waiting and bottlenecking which leads to overcrowding, reduced productivity and suboptimal provision of emergency care. When undertaking efforts to improve patient flow, it is important to understand the steps that make up these processes. In fact, The Joint Commission (JCAHO) recommends hospitals' employ such strategies, within the leadership standard (LD3.15) which states that "The leaders develop and implement plans to identify and mitigate impediments to efficient patient flow throughout the hospital."

ED Solutions analyzes patient flow at a detailed level, encompassing the end-to-end patient experience from arrival through departure. Flow maps are developed through a series of direct observations, shadowing and interviews conducted with ED staff for key processes, including:

• Arrival (Walk In and Ambulance)
• Waiting Room
• Triage
• Bed Assignment
• Patient Assessment
• Diagnostic Testing (Radiology, Laboratory)
• Patient Chart Management
• Fast Track
• Pediatric ED
• Trauma
• Disaster Events
• Patient Transport
• Admission
• Discharge

Through this comprehensive approach, we are able to:

• Define the processes as they are intended and identify deviations in practice
• Highlight non-productive steps within existing processes
• Identify key bottlenecks that present the greatest challenges to efficient and expedient patient flow
• Recommend opportunities for performance improvement

Regulatory Compliance

Emergency departments continue to face challenges of the highly regulated hospital industry. With a greater emphasis on patient safety and reporting requirements, agencies such as The Joint Commission (JCAHO), Centers for Medicare and Medicaid Services (CMS), Office of the Inspector General (OIG) and State Department of Health (DOH) have increased the depth and scope of oversight as it relates to hospital regulations.

Prevailing laws, such as the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA) additionally mandate compliance with their standards which EDs must also address.

ED Solutions closely monitors changes in policy and pending regulations from the major regulatory agencies in healthcare in order to identify resulting implications for emergency departments. Working with our clients, strategic plans are developed to ensure alignment with prevailing statues and regulations.

Our educational materials and training help reinforce these requirements, such as our program on implementing SBAR in support of the National Patient Safety Goal regarding safe patient handoffs.

Staffing/Resource Allocation

The success of any operation is dependent upon the availability of critical resources and emergency departments are no exception when it comes to staffing of personnel, bed capacity, supplies and equipment.   There is no "one size fits all" approach when it comes to developing staffing models for emergency departments.

ED Solutions employs a variety of unique tools and resources towards helping you to identify the right number of resources and staff needed for your operation.

Our ED Nurse Staffing Model determines the appropriate staffing levels for nurses, technicians, clerks and registrars that are needed in your ED. It also answers the question of how many FTEs should be included in the operating budget by considering the patient volume, acuity, length of stay as well.

Other analytic tools are used to calculate the "right" number of ED beds and reference accepted benchmarks to provide you with the information needed to support decision making within your organization.

Patient Satisfaction

"Achieving First Class Emergency Department Patient Satisfaction" is an interactive educational program that helps to increase awareness of patient satisfaction and improve scores. This module based in service is geared for all ED staff including: physicians, residents, nurses, physician assistants, nurse practitioners, technicians, clericals, registrars, security officers and any hospital staff who might interact with patients and their families.

The key topics covered in this presentation include:

• Patient Satisfaction: More Than Just Measurement
• Communication Tips and Techniques
• Handling The Difficult Patient
• Establishing a Service Recovery Program

In addition to this program, we have other tools and strategies that will help you achieve excellence with patient satisfaction through:

• Successful formation of a patient satisfaction committee
• Customized assessment to determine if your ED is maximizing its opportunities to improve Patient Satisfaction
• A customized electronic ED complaint/compliment monitoring and tracking program

Facility Layout, Design and Maintenance

Over 114 million patients were seen in United States hospital emergency departments last year. Yet, the numbers of emergency departments and hospitals has decreased over the last 5 years. To meet this growing challenge, hospitals operating EDs are finding that they are outgrowing or have already outgrown their existing space. In a recent survey of hospital CEOs, it was noted that nearly 65% were either in the process of planning for or had started an ED renovation.

ED Solutions can help with your space planning projects, whether planning for an ED renovation, expansion or construction of an entirely new department. In addition, we conduct a comprehensive assessment of your existing plant to identify aspects which may not satisfy requirements as outlined by JCAHO or be compliant with ADA regulations. Using our resource library, we are able to provide ideas and opportunities to achieve compliance and even improve the usability of existing space.

Hospitals undergoing recent renovation/construction projects have found that the right facility will not resolve overcrowding issues and improve patient flow by itself. Contemporaneous redesign of patient flow processes is an important component of any space planning effort as staff need to adopt new approaches towards providing patient care in a new environment. ED Solutions can help assess the optimal patient flow processes to facilitate a smooth transition into new or expanded space.