Patient Flow Enewsletter
Volume 1, Issue 8
Tuesday, November 16, 2004
With 62 percent of the nation's emergency departments (ED) reporting being "at or over" operating capacity, finding solutions for ED crowding has become more important than ever for a majority of America's hospitals. After examining results from a year-long collaborative designed to reduce crowding in 10 EDs in cities across America, Urgent Matters shares eight key factors for improving hospital ED crowding in a new report: Bursting at the Seams: Improving Patient Flow to Help America's Emergency Departments.
Each of the 10 hospitals in the Learning Network developed, tested and implemented a variety of strategies designed to improve hospital patient flow and to reduce ED crowding. Eight common factors were identified as critical for success, such as securing leadership buy-in and commitment, having multidisciplinary teams in place and identifying the right performance measures.
| "The fact that there were common factors key to success in each institution shows that any hospital can be successful in making changes." |
"The findings outlined in this report should be extremely encouraging to hospitals everywhere," said Marcia Wilson, deputy director, Urgent Matters National Program Office, Center for Health Services Research and Policy at The George Washington University Medical Center, and one of the lead authors of the report. "The 10 hospitals that participated in the Learning Network were very different from one another - they were in different communities, were different sizes and had very different financial profiles. The fact that there were common factors that were keys to success in each institution shows that any hospital can be successful in making changes."
As the number of uninsured Americans reaches 45 million and the country's EDs experience increased demands for service, the ED continues to be a catch-all for America's fraying health care safety net. Regardless of other community health care services that may be available, people in need are increasingly relying on EDs for care.
"This report is important because it focuses on emergency departments, which are the "safety net for the safety net. The findings provide hospitals everywhere with strategies for improving patient flow, the primary cause of ED crowding," said Wilson.
Wilson suggests that other hospitals considering similar changes can use the success factors identified in the report as a checklist for their own organizations. "We learned that all of these factors need to be in place in order for changes to be successful. If other organizations use our findings as a blueprint, it will help identify those factors that may need to be worked on before any new strategies are implemented."
For example, if an organization doesn't have champions in support of the change at the executive level, it may be important to take the time and build this support first. Wilson noted that several of the organizations within the Learning Network tried to implement changes prior to having all of the success factors in place, but encountered substantial challenges. Wilson also pointed out that one of the factors that contributed to difficulties for some organizations in the beginning of the Urgent Matters program was a lack of representation of hospital staff from units throughout the hospital.
"I think one thing that really surprised some hospitals was recognizing that ED crowding was a hospital-wide problem and required a hospital-wide team. When Learning Network hospitals were asked to develop teams, they learned early in the process that teams had to engage staff from every department in the hospital," Wilson said. "Although some hospitals had representation from most hospital departments on their teams, others first mistakenly thought in more restrictive terms when creating their teams, thinking team members only needed to be high-level ED staff members. Those teams generally lacked traction to implement real changes."
Wilson and her colleagues saw staff and administrators at each of the 10 Learning Network hospitals put forth extraordinary commitment and hard work in implementing changes, which proved essential for success. "What we saw was a culture ready for change," she said. "Each of the organizations we worked with set standards for improvement within their organizations and continually challenged themselves on how much they would improve patient flow."
All of the hospitals in the Learning Network showed extraordinary improvements in ED crowding and patient flow. Several of these success stories are included in the Bursting at the Seams report, along with how each Learning Network hospital built a framework for change, applied the eight critical success factors and made successful changes.
Click Here to Download the report (367 KB).
------------------------------------
Marcia Wilson, M.B.A.
Deputy Director, Urgent Matters
The George Washington Univesity
Washington, DC
