Tools, techniques, and best practices in the emergency room

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Emergency services

Sandy Yanko
Management Engineering
HCA - Far West Division

Eddie Gomez
Management Engineering
HCA - Delta Division

Long waits in the waiting room, patients leaving without being seen, patients boarding and holding in the ED, delayed test results, diversions ... Have you encountered these issues in your ED? A highlight of several ED projects at HCA will provide you with a sample of the tools utilized and the results, best practices, and lessons learned.

In the past decade, emergency room visits have increased 20 percent from 89.9 million to 110 million. At the same time, the number of ED has decreased by 15 percent. The time a patient waits for treatment has increase 32 percent to 67.7 minutes. And finally, 54 percent of visits are non- or semi-urgent which has led to increasing numbers of patients visiting the ED.

As an alternative to walking through one project from start to finish, we will utilize HCAs collective resources and knowledge to showcase the tools and results from several hospitals.

Examples of work we have done include:

  • An Excel file was created that matches staffing with patient demand to reduce scenario where patients leave prior to medical screening
  • Examined turnaround times by test, time of day, and day of week to make changes in the way specimens were received and processed in the lab
  • Reviewed the registration process and implemented bedside registration
  • Mapped the patient flow process and implemented any open bed policy and triage standing orders

Some of the keys to success include:

  • Support and leadership of senior executive team in steering committees
  • Involvement of employees and physicians in focus groups
  • Project leader to:
    • Facilitate team meetings
    • Provide analytical support
    • Drive the process improvement changes