Issue link: https://beckershealthcare.uberflip.com/i/674245
63 Executive Briefing for several hours, taking up valuable space there. If these two processes are backed up, the ED waiting room can fill and can even result in ambulance diversion. Patients who call 911 are usually in more urgent need of care than patients who can travel to the ED independently. When ambulances are di- verted, they are taken to a hospital that is not only farther away, but also unlikely to be the hospital where they choose to get care on an ongoing basis. "Doctors have to reinvent a lot of wheels. It makes more waste and it's more disruptive to families, whose loved ones are a lot further away," Dr. Mandavia says. Economic and Noneconomic Costs Traditionally, when hospitals look at EDs and try to calculate the cost of inefficiencies, they look at patients who left without treatment. These LWOTs are patients who come to the ED, but leave because the wait is too long. The costs associated with LWOTs can be characterized by what Dr. Mandavia calls the three R's: risk walking out the door, reputation and revenue. Because these patients were sick enough to come to the ED in the first place, there is some risk associated with leaving before receiving treatment. However, LWOTs typically are still healthy enough to choose to leave, which presents a cost to reputa- tion. "Those are the ones who go to the grocery store and tell their friends, 'I went to general hospital for this and I got sick and left. Don't go there,'" Dr. Mandavia says. Lastly, they often choose to seek care elsewhere, which represents revenue lost to the hospital initially visited. However, Dr. Samaniego says EDs need to look beyond LWOTs. "It is a source of revenue loss, but really with the comparison to throughput value, LWOTs are minuscule," Dr. Samaniego says. She gives the example of an average ED serving 30,000 patients annually. "If you can decrease length of stay by one hour, that could result in an additional 10,000 patients per year. Even if you are only able to keep 50 percent of those patients — an addition- al 5,000 patients — in the average ED with a 15 percent admis- sion rate, that translates into $2.7 million in additional revenue for the hospital," she says. While a one-hour decrease in length of stay may seem impos- sible, Dr. Samaniego suggests considering even a 15 minute decrease. By her calculation, that would result in $1.4 million of additional revenue. "EDs are operating on such a narrow margin. Every minute saved can have an incredible impact on hospitals," she says. The Solution How can EDs and hospitals solve these issues? Dr. Mandavia advises going lean to reduce waste throughout the patient visit and tackle the low-hanging fruit first. He also says EDs should take a step back to make sure they have the right capacity. "The capacity you have more control over is human capital. Do you have the right number of nurses, and are they there at the right time?" he says. "We often don't have the ability to expand beds to overcome capacity issues in less than a cou- ple of years, so this is not a practical solution." Instead, leaders have to make functional capacity by reducing the amount of time patients spend in the bed. This can be done by examin- ing opportunities to reduce wasteful processes, workarounds or redundancies during any part of the patient stay from the triage process to lab turnaround time. Dr. Mandavia recommends seeking input from staff. "They see these problems every day. They live them, and sometimes they have the answer," he says. Listening is critical to engage staff in solving long wait times. "I believe physician leaders play a really strong role in influencing and implementing solutions." Dr. Samaniego adds, "The best way for hospital leaders to engage staff is to involve them in the process, help them un- derstand the problems, make them part of the team and have them be part of the solution — have them benefit from the solu- tion." In doing so, hospital leadership can help staff members feel as though they are part of the solution. Seeing patients more satisfied can be incredibly motivating. "It's not just getting buy in — it's also having a benefit for each person that they can see and feel," says Dr. Samaniego. n "EDs are operating on such a narrow margin. Every minute saved can have an incredible impact on hospitals." — Loretta Samaniego, MD, vice president of physician practice development at Team- Health Sponsored by: At TeamHealth, our purpose is to perfect our physicians' ability to practice medicine, every day, in everything we do. Through our more than 16,000 affiliated physicians and advanced practice clinicians, TeamHealth offers outsourced emergency medicine, hospital medicine, anesthesia, orthopaedic hospitalist, acute care surgery, obstetrics and gynecology hospitalist, urgent care, post-acute care and medical call center solutions to approximately 3,400 civilian and military hospitals, clinics, physician groups and post-acute care facilities nationwide. Our philosophy is as simple as our goal is singular: we believe better experiences for physicians lead to better outcomes—for patients, partners and physicians alike. Learn more at http://www.teamhealth.com.