Application: Improving Patient Flow in Emergency Departments

Nursing

As you learned from Chapter 4 of Hospital-Based Emergency Care and from this week’s articles,emergency departments face serious challenges that impact, and are impacted by, conditions throughout the hospital. Experts emphasize the need to making patient flow more efficient. As noted in the IOM Committee’s report:

Patient flow, defined as the movement of patients through this system, is an important indicator of the timeliness, safety, and quality of the care received. Efficient patient flow ensures maximum throughput (the number of patients treated and discharged from the ED per day), minimizing delays at each point of the delivery process with no decrement in the quality of care. Impaired patient flow, on the other hand, results in bottlenecks that prolong delays for patients already in the system, as well as those awaiting entry (p. 133).

For this Application, you will interview at least one administrator or manager working in a local emergency department to learn how his or her ED has identified and addressed challenges involving patient flow. On the basis of this interview, you will select one of these challenges and do further research about best practices to address this problem.

1.Setting Up the Interview

• Read through the entire Application to gain an overview of this assignment.
• As soon as possible, contact the emergency department at a local hospital and ask to set up an interview with an administrator or manager in this ED. This must be someone who can discuss process improvement efforts in this ED related to patient flow.The interviewee should hold one of the following (or comparable) positions for this ED:

o    Administrative director of the ED (usually non-physician)

o    Chief of Emergency Services or Emergency Department (physician)

o    Nurse Manager for ED

o    Lab Manager or Imaging Manager responsible for supporting ED

• When contacting the department, identify yourself as a student in the Walden University MHA program and briefly describe your objective in interviewing the administrator or manager. Let your interviewee know that you will keep all identifying details (such as his/her name and the name of the hospital) confidential, if desired.

1. Preparing for and Conducting the Interview

• Review the “Input/throughput/output Model” of a patient flow through the ED, on page 134 in Hospital-Based Emergency Care(http://books.nap.edu/openbook.php?record_id=11621&page=134# ). Consider why this is the typical model, and what the pros and cons of this process flow are. Make sure you understand how it represents patient flow.
• Make a list of various issues related to patient flow, as identified in Chapter 4 of Hospital-Based Emergency Care and your other Learning Resources. Note when and why bottlenecks typically occur, and identify other problems in efficient processing of ED patients. Also list strategies used to address these challenges.
• With these thoughts in mind, develop a list of questions about the patient flow process (covering input, throughput, and/or output phases) to ask your interviewee. Through these questions, you should find out about challenges they have encountered regarding patient flow, and ways they have addressed it. Phrase these questions in your own words. At minimum, your questions should encompass the following:

o    What are crucial challenges this ED has faced in recent years related to patient flow?

o    On what basis were these challenges identified? Were quantitative data used to identify and confirm the existence of problems, and if so, which types of data?

o    Focusing on one of these challenges, what process improvement or reengineering efforts has this ED taken to address the challenge?Did the department follow Lean and/or Six Sigma or other comparable approaches in addressing this?

o    Did the ED use any internal or external best practices to make these changes? If so, which ones?

o    Did the organization or ED establish any metrics to determine if expected outcomes are being met? If so, what were the metrics?

o    Did the implemented changes achieve expected outcomes?

• Conduct your interview with at least one of the administrators or managers of a local hospital’s Emergency Department (see list of possible interviewees by title above). Ideally, conduct this interview in person in the hospital. If this is not feasible, however, you may complete this interview by phone. If follow-up questions are needed, these may be conducted by phone and/or email.
• If possible, arrange for a tour of your selected ED, so that you may observe firsthand the layout and other notable features of the ED that may impact patient flow.

3.Completing the Application

• Do further research through Walden Library and/or the web to learn more about the patient flow challenge identified by your interviewee. According to your research, what are best practices for this process improvement issue?
• Write a 3- to 4-page paper in which you address the following:

o    Identify the name and organization of your interviewee (unless that person has requested anonymity).

o    Summarize the responses from your interviewee to your questions.

o    Based on the interview and additional research you conducted, what is the industry best practice for this performance improvement issue?

o    Which key stakeholders are likely to be affected by the performance improvement effort, and how?

o    Provide with any further conclusions about the ED’s operations or layout, and best practices as they relate to the challenges facing this ED.

Additional resources:

• American College of Emergency Physicians: The Role of Metrics in Managing Clinical Operations
  • http://www.acep.org/practres.aspx?id=29960Please scroll to the very bottom of the webpage to locate the link for the PDF of the article.

Review these Web pages for the Institute of Healthcare Improvement’s perspective on need for improving patient flow in emergency and other departments in health care organizations:

• IHI: How to Improvehttp://www.ihi.org/knowledge/Pages/HowtoImprove/default.aspx
• IHI: Flowhttp://www.ihi.org/explore/Flow/Pages/default.aspx
• IHI: Patient First: Efficient Patient Flow Management Impact on the EDhttp://www.ihi.org/knowledge/Pages/ImprovementStories/PatientFirstEfficientPatientFlowManagementED.aspx

Optional Resources

• Article: Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126–136. Retrieved fromhttp://www.sciencedirect.com.ezp.waldenulibrary.org/science?_ob=MImg&_imagekey=B6WB0-4SBRTGR-5-7&_cdi=6696&_user=7754736&_pii=S0196064408006069&_orig=search&_coverDate=08%2F31%2F2008&_sk=999479997&view=c&wchp=dGLbVlW-zSkzS&md5=3378b87fb4130ea7cb816059e75f0fe9&ie=/sdarticle.pdf(Right-click on the link and select “Open in New Window,” or copy and paste in a new browser window.)
• Article: Snyder, K. D., & McDermott, M. (2009). A rural hospital takes on Lean.Journal of Healthcare Quality, 31(3), 23–28. Retrieved fromhttp://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010309452&site=ehost-live&scope=site
• Article: Chassin R. (2008).The Six Sigma initiative at Mount Sinai Medical Center.Mount Sinai Journal of Medicine, 75(1), 45–52. Retrieved fromhttp://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=31822638&site=ehost-live&scope=site
• Article: Marjamaa, R. A., Torkki, P. M., Hirvensalo, E. J., & Kirvelä, O. A. (2009). What is the best workflow for an operating room? A simulation study of five scenarios.Health Care Management Science, 12(2), 142–147. Retrieved fromhttp://proquest.umi.com.ezp.waldenulibrary.org/pqdweb?did=1797479161&sid=2&Fmt=2&clientId=70192&RQT=309&VName=PQD