Our nation's emergency departments (EDs) have never been busier, and demand for care continues to grow. However, increasing patient volume has not been supported by an increase in emergency department capacity. Successful hospitals have optimized their ED capacity by thinking outside of the ED box and integrating processes across hospital departments.
Moving patients through the ED more quickly can serve the same purpose as adding beds, or expanding the physical footprint: more capacity for patients to be seen. One of the biggest delays in care in the ED happens before a patient is admitted. Sometimes called “boarding,” admitted patients wait in the ED until an inpatient bed becomes available. Admitted patients board in the ED for a nationwide average of 92 minutes before being transferred to an inpatient unit or another facility.i
Boarding times are especially high for psychiatric patients, ranging from 6 to 34 hours across the country.ii The opioid crisis, which has caused patients to seek behavioral healthcare in record numbers, has greatly exacerbated the boarding issue.
To end ED boarding, hospitals must shift toward integrated, team-based processes. A collaborative approach to expediting admissions from the ED has many benefits, including:
So when it comes to ending boarding and improving disposition for admitted patients, where can hospital leaders start? Three foundational areas to address are culture, actionable data analytics, and process innovation:
Integration flows naturally when teams across the hospital share the same mission and values. In order to expedite ED admissions, emergency medicine, hospital medicine, and other key services must take joint ownership of patient outcomes. In other words, they must see all patients as "theirs," even when those patients are located in another department.
Successful integration often depends on the department's ability to recruit strong medical directors who can serve as "CEOs" of their respective services. Strong leaders are in the best position to work across practice lines to integrate proven, collaborative solutions.
Strong leaders are also poised to attract and recruit likeminded providers who share their mission and collaborative spirit. These providers work hard to build bridges across service lines, even when it would be faster and easier to "do it our way."
Another way to encourage emergency physicians and hospitalists to work together is to make them jointly accountable for certain metrics. Relevant examples include:
To move the needle on any of these measures, each department will need access to high-quality data. When investing in your health system, prioritize the collection, management, and analysis of data. A strong data infrastructure will often pay for itself in the form of operational efficiency and process optimization.
Working together, acute care teams can design, test, and propagate shared processes that improve communication and performance across departments. Some proven examples include:
ED capacity and throughput challenges should be viewed not as departmental issues but as calls to action for the entire hospital or health system. Reducing boarding time and improving disposition of admitted patients is a significant opportunity to improve patient experience and increase capacity of the ED.
In order to end boarding, hospitals must break down silos and encourage their service lines to co-design new care pathways. This journey to meaningful integration requires time, effort, and culture change. However, it almost always pays off in the form of improved efficiency and patient and provider satisfaction.