Our team of Healthcare Industrial Engineers created this newsletter to share the industry’s best practices with leaders who can apply operational efficiencies in their daily work.
|
|
Extended wait times, driven by throughput challenges, cause patients to leave the Emergency Room without being seen. Efficiency requires coordination among many departments and team members. Each department plays a vital role in ER throughput, contributing to patient experience. From lab and imaging results, to patient registration, to EVS room turnaround time, there are many components which impact department efficiency. Routine reviews of department metrics are necessary to identify throughput pain points that impact both patient and staff satisfaction.
In Health IT Outcomes, Cara discusses how informed staff scheduling in the ER impacts patient care and staff satisfaction.
|
|
|
First, identify root causes impacting ER throughput by reviewing metrics. Second, target improvement opportunities with those teams. Make sure to prioritize efforts with the largest impact on throughput as this highly correlates with patient experience.
|
|
|
Psst... don't forget to align triage nurses with patient arrivals.
|
|
|
|
|
|
1) Review Emergency Room Metrics
Perform review of throughput metrics by triage level and highlight areas with improvement opportunities. Prioritize areas with the most meaningful impact.
|
|
2) Identify Target Improvement Areas
Perform a root cause analysis of metrics exceeding targets and determine the reason for extended times. Common causes could include:
- Extended lab draw times
- Delays in patient registration
- Lack of a low acuity strategy
- Extended radiology wait times
- Provider staffing
- Staff schedules misaligned with workload
- Inpatient holds
3) Interview Front Line Team Members
Interview staff to identify pain points and observed throughput challenges. While much can be gathered from observing, front line team members can describe the nature of the department as they work in it day in and day out. Ask team members questions, such as:
- What are the top operational challenges that you face to support ER throughput and patient engagement?
- Do you believe staff are in the right place in the right time to support patient care?
- What shifts do team members work (7a-7p, 7p-7a, 11a-11p, etc.)?
- Do you feel that the department is overstaffed or understaffed during specific times or days of the week
- List 3 opportunities that you see to improve department efficiency?
4) Perform Direct Observations
Perform observations to further develop recommendations. The busiest time in the ER is typically Mondays during the late afternoon, making this an optimal time to perform observations. Make sure to include the following in the observation approach:
- Begin observations in the waiting room and count the number of patients waiting to be seen
- Observe the triage processes
- Shadow the charge nurse and take note of current department staffing
- Review patient tracker to identify additional delays such as lab or imaging tests
- Count the patients waiting for admission to inpatient units
5) Design Schedule that Aligns Staff with Workload
Review staffing and patient census to determine if the department is appropriately staffed to provide care at all times. Review staffing pain points identified in steps #3 and #4 and begin analysis in these areas.
After completing interviews and observations, combine anecdotal findings with throughput data to highlight top opportunities.
|
|
6) Socialize Recommendations and Develop Improvement Plan
Share results of analysis and provide improvement opportunity recommendations. Collaborate with all key stakeholders to develop a sustainable strategy for implementation and long-term improvement. Adjustments to shift times or removal of certain shifts should occur through attrition to maintain team member satisfaction.
7) Monitor Impact of Improvements
Publish throughput metrics daily, including productivity, to demonstrate the impact of both financial and process improvements.
Orlando Health performed the exercise above and was able to save 2.3 million annually while their Emergency Room patients experienced a 35% improvement in throughput.
|
|
|
Our Denver-based team is looking for our next Healthcare Operations Consultant who is a self-starter and loves challenges. If you have experience in change management in a fast-paced healthcare setting, interested in a position that offers flexibility and growth opportunities, apply HERE - we would love to meet you!
|
|
|
|
|
|
|
