Using Nurse-Initiated Protocols to Improve Patient Flow

Listening to Hear Rate

Busy emergency departments looking to reduce crowding and improve patient flow may not have to look much further than nurse-initiated protocols, a study from the Annals of Emergency Medicine suggests. By allowing nurses to initiate diagnostic tests and provide treatment prior to the patient seeing a physician or nurse practitioner, EDs saw a significant reduction in ED length of stay (LOS) and improved patient flow. Could this type of effort help your ED?

The study, entitled A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department, looked at six nurse-initiated protocols implemented in an overcrowded ED. They then evaluated the effect these protocols had on LOS and times related to diagnostic testing, treatment and consultation.

And the results were promising. The study found that:

  • Nurse-initiated protocols resulted in an 186-minute decrease of the median time it took for patients presenting with pain or fever to receive acetaminophen.
  • A suspected hip fracture protocol resulted in median length of stay decrease of 224 minutes.
  • A protocol targeting pregnant women presenting with vaginal bleeding led to a median LOS decrease of 232 minutes.
  • The ED was able to cut the median time to troponin testing for patients presenting with suspected ischemic chest pain by 79 minutes.

The researchers concluded that “targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay.” That should motivate ED leaders to consider implementing their own set of nurse-initiated protocols, if they haven’t already.

Are there any nurse-initiated protocols your hospital has implemented to improve patient flow that others can benefit from? Which ways have you seen improvements? Are there certain conditions you feel are prime for these type of protocols and could see benefits?

When it comes to patient satisfaction and your hospital’s bottom line, improving patient flow is a smart place to start. If you’re an ED or hospital leader interested in learning more about nurse-initiated protocols and how they can help alleviate crowding in your ED, my company, Donovan+Partners can help. We can assess your current patient flow process and determine which protocols should be established to improve flow, while continuing to provide the highest quality of care for your patients with safety in mind. Please reach out. I love helping EDs maximize efficiency to improve patient care and would love to chat with you.

Also, in case you missed it, check out my blog from last week on one of the first steps in improving patient flow — improving the EMS-to-ED handoff. It covers four strategies you can implement to improve communication and as a result, patient well-being. Several of you also offered your suggestions for improving the handoff of patients from emergency services specialists to emergency department staff.

As a follow-up, how often does your emergency department staff and emergency services personnel exchange interdisciplinary feedback and talk about scope of practice between out-of-hospital and hospital-based providers? How do you go about sharing?


Source: Annals of Emergency Medicine: “A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department.”

Troubleshoot Triage to Improve Patient Flow

Emergency Waiting Room Donovan Partners

Seven years ago — from December 2008 through February 2009 — approximately 13 percent of patients who visited the emergency department at Hahnemann University Hospital in Philadelphia left without ever being seen. Over a three-month time period, the 31-bed ED had more than 8,800 visits — overcrowding was a significant problem.

The very next year, over the same three-month time frame, Hahnemann’s ED saw almost 800 more patients — close to nine more per day — but the LWBS rate dropped significantly. Even with the increased patient volume, the ED’s LWBS rate decreased by more than three percent. Three months later, the LWBS rate had dropped even lower to six percent.

But how?

In June 2008, Hahnemann’s ED leadership made a commitment to improve patient flow, and soon partnered with the Urgent Matters Learning Network II — a 6-hospital collaborative that worked with one another to improve patient flow and alleviate overcrowding. Through the consortium, they were able to develop a triage process that worked for their specific hospital given its size, staffing structure and urban location. (ED leaders at Hahnemann ultimately decided to implement the ESI 5-level triage system; introduce a policy of bringing patients to an open bed for triage and registration; and dedicate resources, staff and space for patient fast tracking. And it worked.)

For Hahnemann, implementing an improved patient flow process at triage resulted in lower LWBS rates, less overcrowding and increased morale among its staff. Higher patient satisfaction scores soon followed.

A more recent example of what can result when an ED prioritizes patient flow is Florida Hospital Tampa (FHT), an ED that had been experiencing a nearly 40-percent annual spike in patient volume as it suffered from a 21-percent staff turnover rate. And if that wasn’t enough, patients were ranking its doctors in the bottom ninth percentile nationwide.

An analysis by the Healthcare Financial Management Association outlines how FHT was able to develop and implement a flexible patient flow process combining two proven strategies: team triage and immediate bedding. Dubbed Doc1stER, the new patient flow triage strategy produced quick results — after two months FTH was the most improved ED in its 41-hospital system.

No two EDs are the same and strategies to improve patient flow aren’t one-size-fits-all — staffing, location and space are just a few factors that have to be considered. ED leaders wanting to improve patient flow triage need a plan tailored specific to their ED. With a proven record of being able to identify and develop patient flow strategies, Donovan and Partners can help you examine and improve your current triage process, and then help you implement a plan to improve patient flow in your ED. Contact us today at or 651-260-9918. To learn more about the complete set of health care consulting we offer, please visit


Healthcare Financial Management Association: “7 Tips for Improving Emergency Department Patient Flow.”

Hospitals in Pursuit of Excellence: “Improving ED Flow through the UMLN II.”

3 Important Characteristics of Emergency Department Nurses and Why We Love Them


It’s easy to take emergency department nurses for granted. Even though they’re what I consider the eyes and ears of any busy ED, they don’t always receive the credit and appreciation they deserve.

Friday marked the beginning of National Nurses Week, reminding us to honor and celebrate these nurses who are so instrumental in providing safe, quality care in the ED. But what makes nurses so amazing? Here are just a few reasons to salute these hardworking women and men who are vital to a successful ED..

Uncommon Agility

You would be hard pressed to find any other profession where agility is so crucial to success. Being agile in an ED means always being on your toes, anticipating the needs of patients, their families and doctors. Agile nurses know what a patient or doctor needs before they themselves know they need it and the right questions to ask. Nurses in many ways have the keen ability to see in the future, which is vital when a life is on the line.

Superb Communication Skills

Anticipating the needs of patients, family members and doctors is one thing — being able to communicate with each of these very distinct groups is another.

First and foremost, great nurses are incredible listeners. They absorb directives from doctors that could easily be drowned out by the bustle of a busy ED. They also connect with patients and caregivers, listening to them in a way that help give the patient a voice in their care.

But listening is only half of communication. Nurses also have to speak with patients in a clear, concise way that’s easy to understand. One minute they may be talking to a 6-year-old boy with a broken arm, and the next, a 50-year-old man with an addiction to prescription painkillers. I can’t think of another profession where one communicates with so many different types of people, across so many demographics and socio-economic groups.

Enduring Empathy

Nurses care about the wellbeing of their patients — though they hope they never see them again, in the ED at least.

Empathy is the reason nurses are able to be considerate and sensitive when setting expectations regarding recovery. Empathy is also the reason why nurses return to work after a hard shift.

The strong sense of empathy that runs through each and every emergency department nurse isn’t always obvious, but we can rest assured it’s there — empathy is the reason nurses show up to work each and every day.

If the emergency department is the front door of a hospital, ED nurses are the ones making the very first impression and make sure that door is open to those who need it most.

One week really isn’t enough time to honor nurses and the important work they do, but National Nurses Week is a nice reminder for hospital leaders, doctors, patients and their families to show their appreciation for everything nurses do.

To learn more about what my company Donovan + Partners does, please check out our new website

In the Emergency Department and on the Field: Teamwork + Talking = Win!

Ever watch the coaches’ post-game interviews after a big game? You often hear the winning coaches give solid communication a big piece of the credit. They say things like, “They did a few things that we didn’t anticipate, so it was a good adjustment on the sideline with the staff and the players. We had good communication there.” -- Iowa University Coach Kirk Ferentz

In the Emergency Department and on the Field Teamwork Talking Win.jpg

And from coaches on the other end of the scoreboard, poor communication can get the blame.

“Yeah, you know I think there is a lot to figure out. I think a lot of that falls back on communication. Sometimes we are communicating well, sometimes we’re not. Different spots in the game and it is really not even week-to-week, it is really drive-to-drive, series-to-series. You know it is really good then it falls down and obviously some of it is holding us back.” -- Buffalo Bills’ Coach Rex Ryan

Both of these quotes are from last month. It’s interesting how team communication on the football field plays a role in success just as it does in the emergency department. Take out the references to sidelines and drives and I am struck by the similarities.

In the emergency room there are always unanticipated things that crop up -- it’s part of the job. Your healthcare providers need a plan for how to communicate those changes to adjust treatment plans.

And while you might have solid communication for the most part, slippage can cause you to fall down. It can cause medical errors putting patient safety at risk. It can also hold your organization back from earning the most it can in the growing pay-for-performance healthcare environment. 

This Thanksgiving here are three communication techniques I am thankful for that can help. I’ve seen them work in many emergency departments to help them maximize communication between doctors and nurses. Bonus, you don’t need an expensive new technology to implement them.

1. Try SBAR at the Get-Go -- This is an acronym that can help nurses remember crucial facts to pass along to doctors or physician's assistants after they do the initial workup of a patient. You’ll want to convey the Situation, the patient’s Background, an Assessment of what you saw and learned, and a Recommendation for action.

Wait? Nurses recommend an action to the doctor? Yes. This type of information can be crucial to a patient’s care. It’s all in how you do it. Let’s put the entire technique in perspective with an example.

A patient comes in after a fall and complaining of hip pain. He’s in his 60s and has diabetes. As his nurse, you help him change into a gown before the doctor comes into examine him, you come to learn his left toe hurts. You check it out and see that it is red and swollen. This isn’t the issue he came in complaining of but it is something that is causing him trouble. It could be from the fall or perhaps even gout. You make a mental note. “It’s probably worth the doctor checking out.” Then, when you give the doctor her briefing, mention it. Here’s how it breaks down: 
Situation -- The patient is complaining of hip pain.
Background – He came in after falling. He also has diabetes.
Assessment – In addition to hip pain he has a red inflamed big toe on his left foot.
Recommendation – You might want to check out his toe while examining him. 

This is a crucial information handoff point in the patient care continuum. But don’t let your in-person talks between doctors and nurses end there.

2. Communicate Face-to-Face Often -- Ah, remember the days of this? I’m only half joking but even in our nonprofessional lives it seems people are shying away from good old fashioned eye contact and human connection.  We have all gotten so busy and have benefited so much from technology tools that many of us now communicate mostly electronically. We’ve come to neglect tried-and-true means of human connection. Nearly a decade ago there was some pushback against this trend in the corporate world. In an effort cut its employees’ dependence on nonverbal communication over the phone or in-person exchanges, a few companies instituted e-mail-free Fridays.

"As a medium, [email]'s inherently ambiguous," said behavioral science professor Nicholas Epley of the University of Chicago Graduate School of Business in an ABC news article on instituting email-free Fridays. "There's not as much information conveyed. The pitch of your voice, the speed with which you say something, the emotional tone that's carried in your voice isn't there."

Sound familiar? The same can be said for relying too heavily on nonverbal communication tools in the emergency department. There are similar reasons to buck this trend of relying on only written communication.

Encouraging face-to-face communication can help build relationships between your staff. And it can be more efficient. Going to find the doctor or nurse you’re working with to tell them something may take time but it can save time as well. You can convey things in the moment and it presents an opportunity for a give and take, and the ability to ask questions and dive deeper to collect all the information in one communication session versus several electronic volleys. So the next time you have an important update on a patient, take five minutes to seek out the team member you’re collaborating with to give them a status update face-to-face.

3. Readback to Confirm the Message Is Received -- While you’re looking each other in the eye, try this one out as well. Most nurses do practice this but sometimes in my consulting work I find it is helpful to go back to some of these basics or foundation elements that are crucial to good communication. Reading back what a physician or physician's assistant says for confirmation can save your team from making mistakes and can even save lives. Was that 2 ccs or 25 ccs? In the nonmedical world, this technique can be called mimicking or rephrasing and is a key element of active listening. It helps signal that the nurse is listening and comprehending. It also provides an opportunity for the physician to reaffirm their order.

This is one little check and balance to add to your team’s arsenal whether it is about medications or discharge instructions. Doctors can try this as well to confirm that they have heard and understand the information nurses have relayed. It even works at shift change. It closes the loop. As the one on the receiving end of communication: Knowing the message you got is the one that the sender intended is a beautiful thing. And as the one doing the reporting of information: Knowing the message you sent was received is reassuring.

These are just three communication techniques you can try to improve communication among your emergency department team. It can be amazing how formulating a game plan for everyone to follow can really help team performance.

 If you’d like help with improving communication in your emergency department, contact me. I’d be honored to help by doing a personalized assessment of opportunities and formulate a customized action plan to put you all on the right path.

Tips to Set the Scene for Open Patient Communication

We’ve all heard the saying, “There is no such thing as a stupid question.” But how good of a job is your emergency department nursing and medical staff at making patients truly feel that way? Your patient satisfaction and HCAHPs scores are riding on it.

Tips to Set the Scene for Open Patient Communication.jpg

Healthcare has become consumer driven. Patient satisfaction surveys ask patients if nurses and doctors care about them, if they were given the information they needed to get well, and whether they are likely to recommend your hospital to someone else. Reimbursement is dependent on the effectiveness of our communication and the effectiveness of our treatment.

Here are some tips to help your team in their communication with patients.

1) Make Eye Contact. To engage the patients and families try being mindful to look them in the eye and listen with a caring and warm attitude.  Recognize this first step is the most important in establishing a rapport and this rapport will most likely set flow for the patient’s entire experience.  

2) Use Your Senses. You want to develop a communication style that is adaptive to the situation and patient you’re working with. Look, listen and feel to understand what is being said and not being said. Empathy and acknowledging the patient’s well-being and comfort demonstrate respect.

3) Anticipate. When you listen to understand your patients and their families it helps you anticipate concerns they may have. This can be very comforting. Anticipating involves knowing customarily what, when, why care is a certain way (process) and then thinking about questions the patient might have about the process but be too intimidated to ask. Try making thoughtful remarks such as “Many patients what to know when the doctor will see you”. Then acknowledge that the doctor has several patients and follow-up with information on how quickly the doctor will see them.

4) Try a Different Delivery Style. Think about creating a relationship where patients feel comfortable talking to us. You can create this type of relationship if you understand how to initiate conversations using techniques called “appreciative inquiry or welcoming questions.” These open channels of communication between patients and caregivers. That’s so important because patients have information that is crucial to helping them get better.

Appreciative inquiry involves framing questions in a way that helps you gather relevant information, foster a give and take in communication, and encourage positive action as a result

Rather than just communicating in short questions or commands, it involves asking an open ended question around the topic you want to address. Then you can guide to conversation to impart important information.

This might be a communication tactic which is different than the informative caregiver mode of communication that you’re used to. It’s no secret nurses and doctors are busy caregivers, we often need to make “a long story short” -- get to the point quickly and with technical accuracy. But while that is perfectly OK and actually important in communication between one shift of nurses to the next or between nurses and doctors or PAs, this hospital-speak is sometimes lost on patients.

In addition to being confusing, it often doesn’t create relationships with patients and family that inspire open and effective communication. Patients can become intimidated and are reluctant to ask questions because their nurse or doctor has such urgency.

How to Use Appreciative Inquiry
Here’s an example you might use when talking to a patient before discharge:

“We have a lot of patients that come to the ED for migraines. Have you sought out help for them from the emergency department before?”

This sets the scene in an empathetic way. You appreciate their problem -- the migraine. You set them at ease by letting them know they are not alone in seeking help for their type of problem and don’t feel scolded for it.

If they answer “Yes, twice before,” you can share information that will direct them toward taking positive action going forward. For example, you could then say: “We know about this clinic where you can get help managing your migraines.”

5) Be patient. Keep in mind that when you try this type of approach you may get more questions from patients. For example, a question about how long they can expect their recovery to take might be something you automatically know. But with patients you can’t take for granted that this is common knowledge. Patients and family don’t know what they don’t know, and need guidance to help them ask the right questions and establish expectations.

Remember, there are no stupid questions. Questions are a good thing. It means the patient is tuned in. Asking questions can help them better understand what role they need to take in recovering. Having an ongoing conversation can help you provide the best care.

Being composed, acknowledging, listening to understand, being responsive, knowing, and caring has the potential to engage and create a rapport with the patient and their family which impacts their overall experience. Interestingly, these approaches to communication can increase understanding, focus and efficiency too.

If you’re interested in talking more about communication techniques or making appreciative inquiry something you practice in your ED, drop me a message. I’m happy to talk more about it with you.

Pay Attention to Safety and Caring and Patient Satisfaction Scores Will Rise

Four Areas to Target Including One Surprise

Patient satisfaction can seem like an ephemeral thing. Is there anything tangible you can focus on to boost it?

Pay Attention to Safety and Caring and Patient Satisfaction Scores Will Rise.jpg

Several studies have indicated that yes, yes there is. It is all about getting back to the basics. It appears that by focusing on things that improve safety and caring, patient satisfaction scores will rise as well.

A review published in the British Medical Journal in 2013 looked at 55 studies that measured care and patient satisfaction in several types of healthcare settings. The idea for the review came about in an effort to answer the question: should patient satisfaction even be used as a measure to rate hospitals?

The review found that, higher patient satisfaction scores were often linked to higher safety and clinical efficiency scores.

“Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations,” said the authors.

If patient satisfaction scores were high, the same hospital was likely to have high patient safety and patient experience scores as well.

Results from a Patient Safety and Quality Care survey of studies in 2008 speculated that this might be because the same things that help prevent serious complications, patient identification errors, infections, medication errors and falls also happen to improve patient satisfaction.

What Steps Can Your Emergency Department Take to Improve Safety, Caring and Satisfaction?

There are many things you can do and I am happy to talk to you about a unique plan for your hospital but for the purpose of this post, we’ll take a look at four biggies.

1) Take a look at communications. Make sure you have procedures in place to make communication of patient information easy. Areas to look at? Transfer of information between caregivers, shifts and different departments within your hospital. Looking at your procedures for intake and discharge can be especially effective.

Nursing leaders, you can reinforce the importance of communication in your rounding and bedside reporting to oncoming nursing staff. Modelling this behavior yourself -- leading by example -- can help ensure the whole nursing staff adopts this approach.

2) Make sure staffing coverage meets the demand for patient care.AHRQ’s Patient Safety Network has concluded what most of us know -- nurses are critical in ensuring patient safety. So let’s help set them up for success. Staff that aren’t pressed for time and stressed running from one emergency to the next has the time to provide quality care. Appropriate coverage also minimizes mistakes.

So how can you make this a reality? Experienced nursing leadership knows the wisdom of a data-driven staffing and scheduling approach. You can use healthcare analytics to understand demand and your functional capacity to solve your staffing challenges.

3) Encourage an environment of trust and non-judgmental for reporting errors. Staff is less likely to report errors or perform well when there is a “blame game” type of atmosphere. Patient safety and satisfaction suffer. Fostering the right culture can help remedy this.

A “just culture” -- one that strikes the right balance between openness and accountability -- improves safety without being arbitrarily punitive. The Leapfrog Group, a circle of large employers focused on improving health care safety, has recognized the importance of a fair and just culture in improving safety.

There is a methodology and algorithm you can apply to help you implement this type of culture and spell out guidelines for appropriate actions when errors are made.


4) Limit noises to promote healing and focus. This one may come as a bit of a surprise. Patient satisfaction surveys tell us patients are not as happy in loud environments. Studies have found that noise hinders healing, causes sleep deprivation, and increases pain.

So upon a second look -- it also makes sense that chaotic unscripted emergency department noise can compromise safety. Researchers have found that louder healthcare environments produce more medical mistakes. It makes it hard to concentrate, may desensitize staff to important alarms, and interferes with the effective communication between caregivers. The Joint Commission made a National Patient Safety Goal on managing clinical alarms systems in 2014. They recognized that if they are not properly managed, they can compromise patient safety.

To take control of noise you need to understand it. Every interaction, every piece of equipment, every medical alarm, every emergency page, and every phone creates noise. Even patients, visitors and others add to it.  

To solve this multi-faceted problem, engage everyone in pinpointing sources of noise and taking personal responsibility to limit it. Sometimes changes to the physical environment can help too.

So Why Does Improving Safety Yield Other Benefits?

None of the study authors pinpointed the whys behind the link between good safety scores and high patient satisfaction. Perhaps emergency departments that rate well on patient satisfaction measures are also paying more attention to safety rules too.

Or maybe it is because people go to emergency departments to get better. When adverse events are kept to a minimum and safety is a priority, people are more likely to improve and heal. It’s natural that those patients will be more satisfied.

What I do know for sure is that when you invest in improving processes and communication to improve safety and care it can yield a double-win!

If you need help examining safety protocols or your patient satisfaction survey results and finding ways to improve, I can help. Contact me. I’d love to talk over your emergency department’s unique situation with you.


Patient Safety and Quality Healthcare: “Safety and Satisfaction: Where are the Connections?”

BMJ Open: “A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.”

AHRQ PSNet: “Nursing and Patient Safety.”

Hospitals and Health Network: “Runaway Noise in the Hospital.”

New England Journal of Medicine: “Balancing "no blame" with accountability in patient safety.” Wachter RM, 2009.

The Joint Commission: “The Joint Commission Announces 2014 National Patient Safety Goal.”

Patient Navigators: Worth Their Weight in Gold

Patient Navigators Worth Their Weight in Gold.jpg

For those of us that work in health care, the ins and outs of how the process works, referrals, follow-ups, prescription instructions, insurance – it’s part of our everyday language. But for the average American, dropping them in the health care system can feel as foreign as plopping them down on another planet.

The rules are different, the language is different, the path is unfamiliar and winding, and there is money as well as their health on the line. It can be downright scary and intimidating. The stress of these challenges can make getting well hard to do. Enter the patient navigator.

What is a patient navigator?
Today, Patient Navigators are on the leading edge of the changing tide of health care. They function differently depending on the situation -- sometimes they provide patient education, other times they operate as a coach and a patient advocate.  

Not investing in hiring nurse navigators for your emergency department may wind up costing you. Why? The beauty of patient navigators is they can help on multiple fronts:

1) They reinforce the patient's discharge instructions and help schedule follow up appointments which helps deliver better patient outcomes. They hook patients up with the right services which helps deliver better patient outcomes.

2) Patients are more likely to follow their instructions, get well, and report higher satisfaction scores. Not only is this what we all wish for our patients but thanks to patient satisfaction surveys and outcome measurement systems, these are crucial areas hospitals are measured on and funding is tied to performance.

3) Because patients are receiving better care, it cuts down on repeat visits and re-admissions – which adds to costs and can be even more expensive in the face of funding penalties

How exactly do they do this?
Patient navigators help patients connect the dots to get the care they need. They are a single point of contact for a patient. They can connect patients with different doctors, primary care specialists and therapy providers. They can track down answers to medication or insurance questions. They make calls to remind patients about appointments and arrange for transportation. It’s their job to follow-up with the patient early and often. For a patient navigator that works with emergency department patients, an initial part of their job would be to contact the patient and make sure they understand and are following their self-care instructions at home. They also work to get them to primary care physicians.

They are especially helpful in working with underserved populations. One study published in the Journal of Healthcare Management defined these as people who are low income, uninsured, publicly insured, or recent U.S. immigrants.

The study examined one Texas hospital’s use of navigators. It found some interesting results. Among folks who less frequently used the emergency department for primary care services, navigators helped decreased their odds of returning to the emergency department. Among patients who returned to the emergency department for primary care, the pre/post mean visits declined significantly over a 12-month pre/post-observation period. The authors also found that by lowering primary care emergency department visits it saved enough money to cover the cost of hiring and training the navigators.

So where do patient navigators come from?
Patient navigation is a relatively new field. Sometimes you may have heard them called nurse navigator, patient advocate, healthcare advocate or consultant, or medical advocate. Patient navigators aren’t providing patient care. They are enabling it to happen.

The story goes that in the ‘80s and early ‘90s Dr. Harold Freeman developed the concept in Harlem after survival rates for women with breast cancer at his hospital were low --  39 percent 5-year survival rate. The expected rate: about percent.

He recognized that it is challenging to get well. A lot of different things have to come together. Additionally, the challenges can be greater if you’re poorer. Time away from work, transportation, and childcare all have a cost. After implementing patient navigators, he was able to raise survival rates to 70%.

The field really began growing in recent years in part because of changes brewing ahead of the Affordable Care Act and the move towards accountable health care and Medicaid penalties.

You should know that because it is a relatively new occupation there is no accrediting body or licensing process. But the industry is moving towards that over the long term. Earlier this month, the National Association of Healthcare Advocacy Consultants just posted best practices.

Right now, if someone wants to become a patient navigator there are training programs, certifications, and even master's degrees that produce some of these practitioners. Some hospitals have had success using peer training programs.

How much does it cost to hire patient navigators?
Accenture and a hospital foundation spent $254,500 to fund six patient navigators for a year-long pilot program. The Bureau of Labor and Statistics classifies navigators as Health Educators and Community Health Workers. They list the median income for 2012 as $41,830 a year. With a nursing degree or other medical training they command more.

If you are interested in hiring, there may be some grants available from government agencies. Big Pharma and other Foundations are also pitching in at some hospitals.

What’s the ROI?
According to Managed Healthcare Executive, the returns on investment are considerable. They reported that the year-long Accenture pilot project in Pennsylvania resulted in a 43 percent reduction in excessive emergency department visits. This was across three hospitals. They helped about 4,000 patients.

It also netted other benefits. “… one system had a 60 percent reduction in 30-day readmissions, as part of a broad set of activities…” according to Managed Healthcare Executive.

That project used non-medical navigators that they trained from the community. This kept costs low.

Another hospital Managed Healthcare Executive reported on, Mercy Health in Cincinnati, Ohio, is expanding its navigator program after its pilot program brought a return of $5 for every $1 spent. The system’s one-year pilot decreased emergency visits by about one third. They brought hospital admissions among the high-risk pool down by one-half. Readmissions were cut by one-third.

Who’s hiring patient navigators?
Even though it is a relatively new field, hospitals are starting to catch on to the real benefits that patient navigators can hire.

While they were first utilized mainly to work with cancer patients and chronic disease like diabetes, hospitals are finding ways to leverage their help in more acute situations.

The American College of Cardiology announced in the fall of 2014 that they were launching a patient navigator program at 35 hospitals across the country. Their goal: reduce unnecessary patient readmissions.

The announcement of the program cited “the stresses of the initial hospitalization, to patient fragility at time of discharge, a lack of understanding of discharge instructions, and the inability to carry out discharge instructions” as reasons that drive patient back for readmission. Patient navigators can help in all these areas.

More Details Please
If you have specific questions about how patient navigators can help your hospital, contact me. I’m happy to talk with you about how your emergency department can work more efficiently and get better results.

Patient Navigator Training Collaborative
Patient Navigator: “Patient Navigators – Who We Are and What We Do,” “Ethical Standards and Best Practices – Final Version Published,” “Training Programs for Patient Navigators.”
National Association of Healthcare Advocacy Consultants – Present at the Creation
Agency for Healthcare Research and Quality: “Connecting Underserved Patients to Primary Care After Emergency Department Visits.”
Accenture: “Jameson Health System Launches Patient Navigation Program with Highmark Foundation and Accenture.”
Mena Report: “Pittsburgh Hospitals Reduce Emergency Healthcare Executive: “Navigators reduce no-shows.”
American College of Cardiology: “American College of Cardiology Patient Navigator Program Completes Hospital Selection.”
Journal of Healthcare Management: “Reducing preventable emergency department utilization and costs by using community health workers as patient navigators.”
CNN: “Helping Patients Navigate the Healthcare System.”