Macro Trends in Emergency Care
According to the Center for Disease Control, the number of ED visits increased from about 96.5 million to 115.3 million in the United States from 1995 to 2005. This amounts to a sharp 20% increase. While this happened, the number of EDs themselves dropped from 4,176 to 3,795. With 219 ED visits per minute in the US during 2005, the ED overcrowding problem has slowly become a nationwide phenomenon. And like with other macro trends, this will replicate itself in other countries as well (if it has not already). In the fastest developing economies (like India and China), this might come sooner than expected. We will examine this and other ED practice trends in future articles. But for now, let us see what some of the best Emergency departments have been doing.
Slicing the Volume Pie
Best practice EDs address the ED overcrowding problem in 3 steps. Seperating out the flow of Urgent vs Semi urgent and Non urgent is the first step in improving flow as over 33% of the patient traffic in EDs is usually of a semi urgent or non urgent type according to the National Hospital and Ambulatory Medical Care survey. Identifying strategies to then take care of these patients in a timely manner is the second step.Setting up efficient Admitting and discharging mechanisms is the third step.
10 Best practices in Emergency Departments to facilitate better Patient Flow
1. Fast track or Urgent Care system for less acute patients
2. Rapid Triage and 5 tier acuity scales (ESI/Canadian Triage scales)
3. Bedside Registrations
4. Improved Communication and Visual indicators (Chart organizers, color codes& Lighting systems)
5. Straight back policy
6. Point of care testing – Lab in ED
7. Computerized Radiology – Picture Archiving and Communication Systems
8. Patient tracking system
9. Patient Flow Coordinator position
10. Continuous process improvement