Posted March 03, 2011

Three Ways Your ED Can Survive and Thrive in the Future

By Stephanie Baker, R.N., MBA, CEN

In 2010, U.S. emergency departments served more than 119 million patients. Certainly, the tide will continue to rise. And with pay-for-performance on the horizon, the performance of your ED—the front door to the hospital—will be critical to your organization's ability to survive and thrive.

But here's the thing: There's no fairy dust to sprinkle. What works? Simple evidence-based tools and tactics that hardwire the delivery of efficient, quality patient-centered care and strong operational performance in the ED.

Tactics That Deliver Results

1. Maximize flow and throughput. What's the best practice? Many high-performing EDs we coach move patients from arrival to discharge in 120 minutes, although nationally, the ED average is closer to three hours.

To identify your bottleneck, begin by tracking key metrics, like patient arrival-to-discharge and door-to-doc times. Looking for a big impact? Make it a goal to reduce door-to-doc time by 20 percent. (Use immediate bedding and streamline registration. Remember, triage is a process, not a place.)

2. Match staffing to flow and throughput. While many organizations try to change flow and throughput, far fewer ever adjust staffing to match it. Try this: Track patient arrivals over 24 hours. Then overlay your staffing pattern. If you are a typical ED, you'll have too many staff members working during slow morning hours and not enough during crunch time. No need to add FTEs…just match staffing to patients.

3. Hardwire accountability. To really hardwire processes that drive measurable results quickly, use tools that validate that the prescribed behaviors are occurring with every patient every time. 

And last, be committed to tackling tough issues that are barriers to excellence in your ED, whatever they may be.

In emergency medicine, what we do is never a job. It's a calling. The good news is we have the answers to the challenges we face. Does it require change? Absolutely! But we're good at change. Change is about choice, and choice is about us. Ultimately, it's up to us.


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