Issue link: https://beckershealthcare.uberflip.com/i/674245
62 Executive Briefing Hospitals: Is Your ED's Length of Stay Costing You Millions? E mergency departments are often inundated with patients seeking acute medical care. The most recent data from the Centers for Disease Control and Prevention show ED visits in 2011 totaled nearly 136.3 million, up 5 percent from 2010. As the population ages and people gain access to health insurance under the Affordable Care Act, demands on EDs have only con- tinued to grow. "That's been the trend over the last 10 years, though it has really accelerated over the last couple of years for a number of rea- sons," says Sujal Mandavia, MD, senior vice president of the west division at TeamHealth, a Knoxville, Tenn.-based outsourced physician services organization. In part, ED volume has grown because the physical number of EDs decreased significantly be- tween the mid-1990s to mid-2000s, according to Dr. Mandavia. Meanwhile, the number of patients has only increased with the passage of the ACA, which provided greater access to health insurance but not necessarily primary care. About half of provid- ers surveyed by the American College of Healthcare Executives said they saw a notable uptick in volume in the first months after the ACA took effect. "[EDs] are the safety net," says Loretta Samaniego, MD, vice pres- ident of physician practice development at TeamHealth. "[EDs] are always there for patients that need us when they can't get care with someone else." While healthcare's safety net is expected to bear the growing patient demand, it has generally had to do so without adequate resources. More than 75 percent of physicians surveyed by the American College of Emergency Physicians felt their EDs were not prepared for increases in demand. Growing ED wait times indicate these physicians may have been right. CDC data from 2011 indicated less than one third of patients — 27 percent — were seen in fewer than 15 minutes at EDs around the country, while the mean waiting time to see a pro- vider was 48.9 minutes. Not only do long wait times put patients at risk and foster dis- satisfaction, but they are generally indicative of operational inef- ficiencies and are associated with significant costs. Fortunately, there are ways to improve processes and engage staff to im- prove capacity in EDs, even without expanded resources. Repercussions of Long Wait Times on Staff and Patients Long wait times negatively affect both the patient and staff ex- perience. Most importantly, long wait times can be a serious threat to patients. "Research has shown in certain conditions, particularly emergent conditions, increased wait time can lead to poor outcomes," Dr. Samaniego says. Perhaps more commonly though, longer delays in care mean the patient experience will suffer greatly. Disgruntled patients who have waited a long time for care and don't understand why start off on the wrong foot. "Patients are starting with a negative experience, and it's really tough to pull them out of that by the end of the ED visit," Dr. Mandavia says. It can also lead to lost revenue — patients who are tired of waiting will often leave and seek care somewhere else. Unhappy patients lead to unhappy physicians and nurses and can even contribute to burnout. Long wait times create a chal- lenging work environment as disgruntled and scared patients relay those anxieties onto caretakers. "We really all went into medicine to take care of patients. That's our goal every day when we go into work. The frustration of wait times and not getting things done in a timely fashion defeats your purpose of provid- ing the best possible care to the patient," Dr. Samaniego says. This frustration can lead to burnout among physicians, nurses and other providers. And as Dr. Mandavia notes, "Unless you have great processes and strong team mentality to start with, it can erode teamwork." Factors That Drive Wait Times While volume is the largest driver of wait times, ED capacity is on the other side of the equation. "The question is whether your ED has the capacity to meet the demands of volume on an hour-by- hour basis. That's where things tend to break down — if there are not enough nurses, providers or beds at a given time, you will have waits," Dr. Mandavia says. Leadership can create capacity by improving processes in the following areas. Door-to-bed time. The time it takes for a patient to come through the door of the ED until they are in a bed can still be decreased in most EDs, according to Dr. Samaniego. "We are looking at an average 20-minute door-to-bed time, and I think that's just waste." Throughput is the time from when a patient arrives in the ED to time the patient leaves the ED (either by discharge or admission to the hospital). "There are a lot of steps that slow that process down, and a lot of them are traditionally put on the shoulders of the hospital," Dr. Samaniego says. A frequent issue that slows throughput is known as boarding — when a physician has decid- ed to admit the patient to the hospital, but the hospital is run- ning out of capacity and the patient must remain in the ED, often Sponsored by: