Patient flow strategies may help to address emergency department crowding
Implementation of strategies to improve patient flow in hospital emergency departments (EDs) may modestly decrease the average ED length of stay (LOS) and the proportion of ED patients who leave without being seen (LWBS), according to a new study. Five hospitals implemented a total of seven improvement strategies over 18 months as part of a collaborative to improve patient flow and reduce crowding in the ED. By the end of the collaborative, four of the five hospitals had at least one fully implemented improvement strategy. Those hospitals showed modest improvements in patient flow. The improvement strategies and associated impacts on LOS and LWBS varied considerably across the five hospitals.
For example, one hospital that both implemented front-end improvements (such as a more efficient intake process for nonurgent patients) and devoted additional staffing resources for fast-track patients had a 51-minute reduction in ED LOS. Another hospital that implemented only front-end improvements had a 9-minute reduction in LOS. A third hospital that improved communication between the ED and inpatient units to facilitate hospital admissions reduced the proportion of patients leaving the ED without being seen from 0.6 percent to 0.4 percent.
A fourth hospital reduced LOS by nearly 1 hour (59 minutes) for mid-acuity patients by establishing a new expedited care process for them.
Although most changes were small, the largest improvement for all ED patients occurred at the hospital that fully implemented two of its three proposed strategies. This hospital also had considerably longer LOS than the other hospitals and the national average. The authors note that a variety of factors may influence the success of strategies, including the challenges encountered, the time-frame of implementation, and the type of strategy selected.
More details are in "Changes in patient flow among five hospitals participating in a learning collaborative," by Megan McHugh, Ph.D., Kevin J. Van Dyke, M.P.P., Embry Howell, Ph.D., and others in the September 13, 2011, Journal for Healthcare Quality (Epub ahead of print).
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