Becker's Hospital Review

14 Executive Briefing "We look at alignment of resources and make sure they're paired up with demand coming through the door," Dr. Crane says. With a firm understanding of your ED's problem areas, ED leaders can take action. Dr. Crane recommends mapping out an ED revamp in the following four steps. 1. Build an improvement team. Identify every person who touches a patient and map the exact flow of the patient's journey through the ED. This visual presentation will help uncover hurdles that need addressing. 2. Conduct a streaming analysis. Historically, the focus of an ED has been on accelerating the "door-to-doctor" process. Now, there is a shift toward improving the "door-to-in-process," which goes beyond door-to-doctor to include completion of testing and treatments during the encounter. To improve this time, organizations need to determine the acuity mix of their ED patients via a streaming analysis, in which organizations measure the number of low-acuity, mid-acuity and high-acuity patients coming through the door each day. "Try to understand, based on your specific volume and acuity, what the right care pathways are for those patients. Some EDs may need no pathways and some may need two or three," Dr. Crane says. 3. Align staff. Much like a streaming analysis, a staffing analysis forecasts patient demand for services every hour of the week, and even by season. Armed with this information, ED leaders can match staffing to expected demand to ensure coordination and optimization of staffing resources between physicians, advanced practice clinicians, and nurses. Physicians and nurses in particular compose two major resource groups in an ED, and hospital leaders are tasked with getting the mix right. When an ED is short a nurse, it doesn't matter how many physicians are working, and vice versa — the patient will not move through the system efficiently. "Staffing is really important relative to flow," says Dr. Crane. "The alignment through the week and the absolute numbers — you have to make sure you're in a range." 4. Keep an eye on the backend. Within the ED, it's imperative for physicians and nurses to practice handoffs. However, ensuring smooth patient flow on the backend may require restructuring on the inpatient side. "[Assess] flow management within the hospital, from speeding up discharges and really addressing the bed availability issue," says Dr. Crane. How to keep a finger on the pulse of your ED Initiating change requires commitment, and leaders need to champion the new future. Dr. Crane refers to this process as "unfreezing" the ED, in which a team objectively analyzes the department's current state and decides where the department needs to go based on metrics. "Part of that change involves visualizing what the future state should look like," Dr. Crane says. "We design a new system that could potentially work." Major behavioral change requires a gentle hand. Don't jump in full force with the new system, but rather initiate rapid cycle testing. Try out a new patient flow process on a historically non-busy day. If it works well, try it on a busy day and then for a week. If it still operates smoothly, implement it permanently. "[Rapid cycle testing] enables you to safely try a new process and objectively look and see if you've improved your metrics," Dr. Crane says. "We engage folks by giving them a taste of the future." He also encourages involving the C-suite by inviting executives to do a round in the ED and engage with the front- line staff. Once a new system is in place, keep an eye on these seven "power metrics" to monitor patient flow: 1. Door to Doc 2. Left without being seen 3. Discharge length of stay 4. Admitted length of stay 5. Boarding hours 6. Provider productivity 7. Patient experience "When we're monitoring, we track the most important metrics with a dashboard and compare them with CMS benchmarks," says Dr. Crane. How TeamHealth can help Improving patient flow in the ED can have widespread, positive effects on operations hospital-wide. Hospital leaders considering addressing their patient flow concerns head on need not feel overwhelmed, however. With its roots in emergency medicine, TeamHealth has almost 40 years of experience offering support services, communication networks and educational resources for emergency medicine professionals. TeamHealth's thousands of emergency medicine providers continue to develop best practices to deliver the highest standards of evidence-based care. The company can help your hospital monitor and enhance patient flow and develop triage and staffing models to ensure a top-performing ED. n At TeamHealth, our purpose is to perfect our physicians' ability to practice medicine, every day, in ev- erything we do. TeamHealth offers outsourced emergency medicine, hospital medicine, anesthesia, orthopedic hospitalist, acute care surgery, obstetrics and gynecology hospitalist, urgent care, post- acute care and medical call center solutions to approximately 3,200 civilian and military hospitals, clinics, physician groups and post-acute care facilities nationwide.

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