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Cover Story: ER/ICU Management Speeding up the ED care process

Three hospital organizations mitigate overcrowding by improving patient flow, processes and documentation.

By Robert Hitchcock, M.D.

orkflow and process optimization go hand in hand when improving throughput to accommodate a high volume of patients through the crowded emergency department (ED). In a worst-case scenario, patients could suffer for hours in the waiting room before they are treated. Those weary of waiting are walking out sans treatment, potentially putting their safety at risk. ED physician and nursing workflow, recognized as a driver of efficiency, can drastically slow patient flow and throughput if left broken and unattended. Studies have documented that low throughput has severe negative implications for EDs and hospitals. Lost revenue opportunities include, for example: each patient leaving without being seen costs the hospital $300 to $500; each ambulance diverted due to no available beds costs the hospital more than $3,000; and for every 75 out of 100 unsatisfied patients, expect that they will share their unhappy experience with 465 potential patients who may choose a different provider. To resolve this concern that is universally plaguing the U.S. emergency care system, three hospital organizations varying in size have implemented the T SystemEV ED information system (EDIS). Each provider has embraced the technology to provide more timely and higher quality ED care to its respective communities.


Hardin Memorial Health A 300-bed not-for-profit institution, Hardin Memorial Health is a collection of health facilities in Hardin, LaRue, Meade and Nelson counties in Kentucky. Its Hardin Memorial Hospital in Elizabethtown serves a 10-county area with a population of 350,000.

Though the Hardin Memorial Hospital ED’s patient volume is expected to exceed 58,000 this year – which was well beyond its intended patient capacity – administrators were determined to improve throughput processes at every care point to enhance the experience of its patients. According to monthly figures, up to 5 percent of patients left the ED without seeking treatment. The door-to-room time


averaged 40 to 50 minutes. Average ED door-to-provider time approached 71 minutes, and average length of stay for discharged ED patients was calculated at 216 minutes. To quickly relieve overcrowding and other emergency care concerns, Hardin Memorial implemented an EDIS this past summer and saw a dramatic improvement in its patient flow metrics.

Getting 100 percent of physicians adopting the EDIS within nine weeks of activation on June 5 was the first step helping instigate major change. Hardin Memorial Hospital’s ED was able to decrease its average patient door-to-room time by 22 percent, from 45 minutes to 35 minutes, and its average length of stay for discharged patients by 13 percent, from 216 minutes to 187 minutes.

“High patient volumes in the ED can adversely affect patient care and safety,” says Tom Carrico, vice president, Hardin Memorial Hospital. “Our EDIS put us on the right track to resolving throughput issues so we can provide more timely care to our community’s most critically ill and injured patients, as well as the growing number of non-urgent patients.”

Hardin Memorial also used the EDIS to streamline processes affecting patient safety and provider efficiency.

Robert Hitchcock, M.D., FACEP, is VP and CMIO, T-System Inc. For more on T-System: www.rsleads. com/212ht-208


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