October 19, 2015  |  Delia Caldwell

Maybe you have a new emergency department (ED) under construction, or work in a newly built ED. But what if it wasn’t designed in conjunction with your specific operational processes? Either way, you will be challenged to work within the confines of the new space and meet the increased expectations that accompany it. Just because… | Read More

May 27, 2015  |  Kathy Clarke

Every system has surges in volume, whether they are predictable or unpredictable surges. Most facilities were not designed to handle either type of surge – it’s simply not cost effective. But staff can make the best of their inflexible facilities by knowing what to do in case of a surge in volume. In the previous… | Read More

May 26, 2015  |  Kathy Clarke

Every system has surges in volume, whether they are predictable or unpredictable surges. Most facilities were not designed to handle either type of surge – it’s simply not cost effective. But staff can make the best of their inflexible facilities by knowing what to do in case of a surge in volume. There is a… | Read More

May 6, 2015  |  David Martin and Kathy Clarke

“Security presence” in the emergency department can be as simple as an officer sitting in a chair at the greeter desk. Or it can be as involved as a metal detector, a canine team, and ambulance patient wanding. The level of security that is right for your hospital is best determined by local security and… | Read More

April 15, 2015  |  Kristyna Culp

On any given day, a hospital knows its quantity of surgical patients because they schedule cases at least a week in advance. They can also predict the number of discharges and unscheduled patients even though they may seem random. With less precision, of course, but determining patterns and average ranges is not rocket science. When… | Read More

March 26, 2015  |  David White

We’ve always heard that behavioral health emergency department visits correspond to the full moon. Because a literature review found no significant correlation, we decided to delve into the data to see for ourselves. Our quick and dirty informal analysis revealed some surprising conclusions. We gleaned arrival patterns for 120,000 behavioral health patients from two emergency… | Read More

March 18, 2015  |  David Martin and Kathy Clarke

Many emergency departments (EDs) care for the types of detained patients who require a legal blood draw to validate alcohol intoxication levels, or who sustain injuries from an altercation. However, a select group of emergency departments service a substantial volume of medium to maximum security patients brought from local, state, and federal prisons for emergency… | Read More

March 11, 2015  |  Kristyna Culp and Kathy Clarke

We encounter “scripting”, or standardized responses, every day. Order a cheeseburger and the cashier will ask if you want to Supersize it. Rent a car and the staff will ask whether you prefer the gas purchase option. Fill up with gas and the screen on the gas pump asks if you would like a car… | Read More

February 19, 2015  |  Delia Caldwell

Like most people, within hours of purchasing my first Iphone, I discovered game apps. Since that time I have spent entirely too much time playing them. One game in particular, Diner Dash, has taught me some valuable lessons about optimizing emergency department throughput. The basic premise of Diner Dash is that Flo, the proprietress, acquires… | Read More

February 3, 2015  |  Kathy Clarke

Once an Ebola patient presents at the ED, they must proceed from triage or the EMS entry directly to an isolation room. We developed a range of solutions for converting or creating isolation space to comply with the October 20, 2014 CDC guidelines for PPE donning, doffing, and staff observation. Approaches vary from interim configurations… | Read More

January 28, 2015  |  David White

Many would suggest that Freestanding Emergency Departments (FSEDs) are a suboptimal strategy for the following reasons: Locating FSEDs where patients are insured by the best payors rather than in underserved communities with the highest utilization potential is not consistent with the premise of population health; Non- urgent patients use FSEDs for care that could be… | Read More

October 14, 2014  |  Delia Caldwell

I’m on a campaign to remove hallway beds from emergency departments across the country. Perhaps this seems like an unorthodox idea, but three factors convinced me that hallway beds do not belong in the ED. 1) Adding more capacity in the form of hallway beds typically increases LOS because it creates more places to “store”… | Read More

September 10, 2014  |  David White

To continue our discussion of Emergency Department utilization and regional utilization trends, today we examine the adult obesity rate data published last week by the CDC. These results suggested some interesting insights, including the fact that the two states with the highest self-reported adult obesity rates also have the highest statewide ED use rates (visits… | Read More

August 27, 2014  |  Delia Caldwell

Emergency physicians can employ the following patient flow techniques to expand their capacity and evaluate more patients. USE OF SCRIBES Hospitals increasingly depend on physicians and nurses to capture data to help them meet reform requirements to earn incentive dollars and avoid financial penalties. Proper documentation to support the level of services provided is always… | Read More

August 20, 2014  |  Kristyna Culp

Whether you’re talking about the people, spaces or equipment in an emergency department, one can always find ways to increase efficiencies. But as you work toward that goal, it’s helpful to recognize that achieving 100% utilization or efficiency is simply not possible, nor even desirable. Rather, it’s wise to build in a little slack or… | Read More

August 18, 2014  |  David White and Michelle Mader

Most hospital administrators question the future impact of the ACA on Emergency Department (ED) visits and resulting treatment space need. Will volumes continue to grow in spite of ACA reforms? Nationwide ED volumes grew 16% in the past twelve years. Round-the-clock access, inexpensive co-pays, diagnostic convenience, and medical home scarcity contributed to this growth rate…. | Read More

August 13, 2014  |  Jane Stuckey

In the “good old days” of healthcare — and by that I’m talking about as recently as 20 years ago — caring for patients was simpler. The doctor or nurse provided the care, and the patient received it. Simple. The language we used reflected this paradigm. For example, we referred to the patient as the… | Read More

August 1, 2014  |  Kristyna Culp & Katie Fricke

On Wednesday, one Charlotte hospital changed the national conversation about the devastating Ebola epidemic in West Africa when it was forced to close part of its ED to isolate a possible Ebola patient. While the action taken was decisive and appropriate, this event – coupled with Thursday’s announcement that Emory University Hospital will be treating Ebola… | Read More

July 30, 2014  |  Kristyna Culp, MBA

Across the healthcare system, people and organizations are seeking to increase efficiency. But not all “wasted time” in healthcare is truly wasted. Some of the most important aspects of healthcare are less than 100% efficient by nature. Of course, we can and should strive for greater efficiency. But we also must understand that absolute efficiency… | Read More

July 24, 2014  |  Jane Stuckey

It’s easy to forget that not all of the health benefits that we provide to patients are in the form of actual medical treatment. In fact, some of the benefits come from educating patients about their condition and treatment leading up to and following discharge. Based on my own research and other studies of patients… | Read More

July 17, 2014  |  Kristyna Culp, MBA

Give a gas more space, and it will expand to fill that space. The same goes for people — and this tendency offers some important lessons for emergency department planners. When an ED has too much treatment space, it can actually slow down the process. Finding the right balance When I’m on a project consulting… | Read More

July 15, 2014  |  Delia Caldwell, MBA

For emergency departments engaged in healthcare benchmarking, it might seem natural to focus on tracking median statistics for patient care — such as Time to Provider and Length of Stay for Discharged and Admitted patients. But relying solely on median numbers, in my experience, tells only part of the story — and a slightly skewed… | Read More

July 2, 2014  |  Kristyna Culp

Every emergency department is interested in improving efficiency — but not every one can afford to renovate. Fortunately, there are a variety of strategies an ED can adopt to increase efficiency using their existing facilities. In fact, many of our clients hire us to help choose the strategies that make the most sense for a… | Read More

June 18, 2014  |  Jane Stuckey

Some people assume that one of the factors driving inappropriate use of emergency departments is the fact that they’re always open — and thus more convenient for patients. However, two recent studies, in Colorado and Oregon, have determined that time of day is typically not a factor in patients’ choosing the Emergency Department, even for… | Read More

June 11, 2014  |  Delia Caldwell

In 2013, CMS made reporting of certain emergency department statistics mandatory. In 2014 those reportable statistics were broadened. These ED core measures are reported as part of the Hospital Compare initiative that allows healthcare consumers to compare services and metrics among hospitals. Currently, CMS takes a small patient sample from EDs for reporting; hospitals do… | Read More

June 4, 2014  |  Delia Caldwell

As EDs look for ways to improve efficiency, one possibility is to consider is the registration process. It’s an essential step in getting the patient into the workflow of the ED, yet in practice it can often become a bottleneck. There are a variety of approaches that EDs are following to rethink registration — ranging… | Read More

June 3, 2014  |  Delia Caldwell

Today, more and more hospitals are adopting protocol-driven (or template-driven) approaches to emergency department procedure. When an ED implements protocols effectively, these methods can dramatically improve emergency department operations and deliver care more quickly. Yet protocol-driven medicine is not a universal practice. Why are protocols important? How does protocol-driven medicine reduce wait times? And how… | Read More

May 21, 2014  |  Delia Caldwell

While emergency department usage is by its nature random for most individuals, there is a small percentage of the population for whom it is a more common occurrence. These are the superusers, and almost every ED has its share. For efficiency’s sake, what’s the best way to serve these individuals? Understanding Superusers To begin with,… | Read More

May 15, 2014  |  Kristyna Culp

Emergency care is by its nature a complex, fast moving world, in which effective communication between members of the care team is vitally important. Todd Smith, a Ph.D. candidate and AG-ACNP student at the University of Virginia School of Nursing, is studying the communication between paramedics and nurses, and looking for ways to improve it…. | Read More

May 13, 2014  |  Delia Caldwell

When many people hear the term “triage,” they think of a place — a room or perhaps even a chair in front of an Emergency Department reception desk. In this case, triage is a noun, a physical space where a patient goes for initial evaluation and vital assessment before moving on to see a nurse… | Read More

May 8, 2014  |  Delia Caldwell

There has long been a tradition in emergency departments — some might even call it a bias — of relying solely on physicians and nurses as the providers of medical care. Times are changing, however, and the use of mid-level providers, particularly Physician Assistants (PAs) and Nurse Practitioners (NPs), is allowing many EDs to bring… | Read More

May 6, 2014  |  Jon Huddy

As emergency departments continue to adapt to changing political and economic landscapes in the US, it can be instructive to look to strategies employed elsewhere for lessons. Hospitals in the UK offer examples of both adaptive tactics for more efficient emergency departments — and potential pitfalls. How do some prevailing approaches to emergency department design… | Read More

April 30, 2014  |  Kathy Clarke, RN

The team staffing model was originally established in California in 2001, and has since proven to be a highly effective approach — in part because it allows significant room for variation and adaptation to meet the particular needs of an ED. At the core of the model is the “ideal” or targeted ratio of 1… | Read More

April 23, 2014  |  Jon Huddy

Many hospitals recognize that major decisions lie ahead for their emergency departments — beginning with how to meet demand that continues to increase, despite a variety of efforts to reverse the trend. ED usage soared over the past decade, rising from an average of about 380 ED visits per 1,000 population per year (or ~380/1,000/year)… | Read More