An optimized patient flow process is critical to effectively transfer patients from the emergency department to an inpatient unit. Often, it’s not the patients in the waiting room that weigh heavily on an ED’s resources and signal an issue with crowding; it’s the number of patients waiting to be admitted to the hospital from the ED.
It’s not always easy as an ED leader to effect change in another department such as an inpatient unit. But it is important to work in tandem with other hospital leaders and administration to improve the patient experience for all patients whether they’re discharged straight from the ED or require more long-term care as an admitted patient. While the ED often functions as the front door to the hospital, it’s much more than an entryway — it’s a place where great care and treatment begins. High quality of care must continue in a safe and timely way as patients are transferred out of the ED.
Here are a few steps ED leaders can take to reduce the time needed to transfer patients from the emergency department to an inpatient bed.
Reduce your nurses’ patient loads.
This story from the Institute for Healthcare Improvement offers a great example of how implementing a few changes, such as improving the patient load of your nurses, can help reduce the amount of time it takes to transfer ED patients to an inpatient bed.
How did they do it? The patient flow team at Lee Memorial Hospital in Fort Myers, Florida, led by Linda Biittner, R.N., reduced their nurses’ patient loads from four patients to three patients per nurse. By reducing the nurse-to-patient ratio, nurses were far more productive, and patients were discharged faster. This “counterintuitive” strategy also proved critical to reducing transfer time by 80 percent.
Keep an eye on your metrics.
The flow team at Lee Memorial also implemented a computer-based system to track how long admitted patients had been waiting in the ED. According to Biittner, the system allowed her to have a better understanding of how patients were flowing through the ED, allowing her the opportunity to know how long patients were waiting and how much time doctors were spending with each patient.
Create a line of inter-department communication.
Opening a different line of inter-department communication was another tactic Biittner employed to help reduce the amount of time it took to transfer patients from the ED to an inpatient bed. When these changes were implemented back in 2004, ED staff replaced lengthy phone calls to inpatient units with faxes. Additionally, a bed turnaround team was created to ensure beds were ready for patients upon arrival, and bed turnaround time was reduced by more than 15 minutes.
But what happens if there are no inpatient beds available?
Don’t board them in the hallways of the ED, board them in inpatient hallways. Thisstudy from the Annals of Emergency Medicine provides evidence that admitted patients prefer to be boarded in inpatient hallways as opposed to the ED. There’s a direct correlation between ED boarding and overcrowding, so if ED and hospital leaders are able to move patients to an inpatient unit, even if no bed is available, patients are more likely to express higher levels of satisfaction, and ED crowding will be reduced.
Has your emergency department successfully reduced the amount of time it takes to transfer patients from the ED to an inpatient bed? Comment below, or feel free to drop me a line to share your experience.
Institute for Healthcare Improvement: “Reducing Transfer Time from the Emergency Department to Inpatient Bed: Lee Memorial Hospital”
Annals of Emergency Medicine: “27 Patients Prefer Boarding in Inpatient Hallways: Correlation With the National Emergency Department Overcrowding Score (NEDOCS)”