How an Improved Patient Flow Process Makes Your ED Safer

Patient waiting a doctor in hospital

An optimized patient flow process offers several benefits for the emergency department. For example, efficient patient flow allows EDs to manage increased patient volume and throughput. It also reduces the costs incurred by EDs as a result of extended lengths of stay and boarding. EDs with an established and sound patient flow process experience higher staff morale and increased levels of patient satisfaction. Most importantly, improving patient flow increases patient safety in the emergency department, which is critical for ED and hospital leaders focused on patient experience.

We can all agree that emergency department crowding is, by and large, the greatest threat to patient safety. I discussed this correlation in a recent blog post, but I wanted to take some time to talk more about how an optimized patient flow process counters overcrowding and will lead to improved safety in the emergency department.

For patients experiencing life-threatening conditions— such as strokes, heart attacks and trauma — time is of the essence. Staff also must be able to have the confidence that bottlenecks or barriers to care do not appear when treating patients with these conditions. Inefficiencies in the ED may place undue stress on nurses, physicians and support and result in increased workloads, all of which pose a threat to patient safety. But when an optimized patient flow process is in place, ED and hospital leaders can be assured their patients will receive complete, comprehensive care without a risk to staff morale and patient safety.  

ED leaders must also understand the effects of bottlenecks and barriers to care in the ED can put a strain on other areas of the hospital, such as inpatient units. Rapidly admitting patients to inpatient units does little good if no beds are available. Efficiency isn’t really about the speed in which an ED admits, discharges or transfers a patient. It’s about providing quality care that’s appropriate while effectively managing the expectations of patients and their families along with relevant staff stationed throughout the hospital. If the ED is the front door of the hospital, it’s also where the flow of patients begins and the foundation for a culture of patient safety.

Delivering quality care promptly within the ED isn’t the only factor that contributes to this culture of patient safety. Effective communication and teamwork is also critical to patient safety and patient flow. Miscommunication takes an immense toll on an ED’s tally of preventable medical errors. If you’re an ED or hospital leader who has made the wise decision to revamp an inefficient patient flow process, make sure your communication strategy is tailored to the new plan. Communication is especially important during the implementation of any new or updated plan, no matter the performance areas you’re focusing on. Open-door policies, standardized communication practices and deep analysis of existing and potential communication structures are all proven strategies to increase patient safety and improve patient flow.

Need help improving your ED’s patient flow? Schedule a complimentary phone consultation with Connie Donovan to discuss what’s happening in your ED.


Agency for Healthcare Research and Quality: “Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals”

Agency for Healthcare Research and Quality: Patient Safety and Quality: An Evidence-Based Handbook for Nurses

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.”

Patient Safety: How to Improve the Patient Handoff Process

Patient exiting ambulance

The patient handoff process is one of the most critical moments for patient safety in an emergency department. When emergency medical services personnel arrive at your door with a patient, challenges will arise, and an appropriate response by Emergency Department staff is necessary for a successful handoff.

When it comes to an EMS-to-ED handoff the greatest challenges lie in communication. There’s an increased potential for miscommunication — or lack of communication — that can have dire consequences for the patient.

Researchers recently evaluated 90 patient handoffs, studies of which have been limited when it comes to components of quality care. Looking at communication between EMS personnel and ED staff during the handoff, researchers found that EMS personnel provided ED staff:

  • Information related to the patient’s chief concern 78 percent of the time;
  • A description of the scene in 58 percent of all handoffs;
  • A complete set of vital signs in 57 percent of instances;
  • A description of physical exam finding for 47 percent of patients;
  • An overall assessment of the patient’s clinical status in 31 percent of cases.

Researchers did note that handoffs between certified paramedics and ED staff resulted in higher instances of communication of vital signs and physical exam findings, and that paramedics offered an overall assessment more than twice as often than other levels of EMS staff such as EMTs.

This study confirms that there is significant room for improvement during the handoff process of critically ill and injured patients, researchers concluded.

So how can the process be improved in order to provide patients with the high quality of care they expect from EMS providers and ED staff?

Another study looking at this same topic found that EMS providers often saw themselves “as advocates for their patients during the challenging EMS-to-ED handoffs.” And they, in turn, offered four strategies for improving the handoff process, some of which address issues related to communication, while others addressed EMS and hospital protocols that make handoffs more challenging.

Tactics EMS providers suggested include:

  1. “Communicate directly with the ED provider responsible for the patient’s care.”
  2. “Increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers.”
  3. “Standardize some (but not all) aspects of the handoff.”
  4. “Harness technology to close gaps in information exchange.”

While these solutions offered by EMS providers have the potential to be effective ways to improve the handoff process between EMS and ED providers, buy-in would be necessary from the ED standpoint.

Do you think these solutions are reasonable? What can emerFgency departments do on their end to help facilitate a safe, high-quality handoff experience for patients? I’d love to hear your thoughts. Comment below or feel free to drop me a line.


Prehospital Emergency Care: “Quantitative Analysis of the Content of EMS Handoff of Critically Ill and Injured Patients to the Emergency Department.”

Annals of Emergency Medicine: “Optimizing the patient handoff between emergency medical services and the emergency department.”

How Real-Time Analytics Will Revolutionize Patient Flow in Emergency Departments

Female doctor using ipad while working in hospital

A new and important tool has emerged to greatly improve patient flow in the emergency department (ED) — real-time analytics. By analyzing real-time data to predict potential surges in patient volume, EDs are able to take a proactive approach to optimizing flow. As a result, EDs are able to quickly alleviate crowding and improve the overall quality of care patients receive.

Brent Newhouse, co-founder and head of customer success at analyticsMD, is helping hospitals across the country streamline operations by leveraging real-time analytics. The use of analytics in hospitals is growing, he says, and the results are very promising.

How it Works

Most hospitals live in a reactive world and aren’t using real-time data and computer-driven models. To many the idea may sound futuristic, a little mysterious, a little like Moneyball. But without predictive and prescriptive analytics, hospitals can react, at best, only after an issue has presented itself. Even worse, ED leaders may not know a problem existed until weeks later, after the monthly report is generated, says Newhouse.

In the world of real-time data, predictive and prescriptive analytics can help shape the choices ED leaders make to improve patient flow in real-time. Those working in the ED can follow all this data on a dashboard setup on a computer.

How to Ensure Positive Outcomes

Being able to predict and anticipate a problem is the first step. Taking action based on that prediction is the only way to ensure a positive outcome. With real-time, data-driven models, ED staff are now able to know exactly when patients arrive; how many are waiting and for how long; and where their patients are in the treatment process at the glance of a dashboard.

What’s the Difference Between Predictive and Prescriptive Analytics?

Predictive analytics approximates when a potential surge in patients may be expected based on incoming data; while prescriptive analytics uses this data to provide a recommended course of action, explains Newhouse.

Predictive programs, such as those offered by analyticsMD, are able to determine when patient surges will take place — something that is harder for someone who wasn’t a quantitative math or statistics major to figure out in a moment’s notice. What a huge benefit considering that when EDs become overcrowded, it’s often too late to do something about it. The use of real-time analytics allows EDs to nip problems in the bud and better anticipate and avoid bottlenecks related to surges in patient volume.

For the prescriptive part, these programs can also recommend generally what actions can be taken to alleviate or avoid the issue altogether, which decision-makers can then take into account when making the final decision.

However, in my experience in managing EDs, I should note that, as a rule, prescriptive analytics is not as fully of a developed technology as predictive analytics is at this time. It is just harder for a computer to make some of the judgment calls that an experienced human can. So it’s good to remember that these programs are not meant to replace human decision makers — the experienced health professionals all EDs depend on. Rather they are intended to be tools that vastly improve the information decision-makers have at their fingertips. It can help folks on the ground so they can make wise decisions more quickly — saving time and improving quality of care. That, in turn, makes for happier patients and maximized reimbursements.  

Real-Time Tracking of Resources

Another benefit data analytics can offer your ED is resource management info. If there are certain resources within an ED that are being underutilized, data programs can identify those resources, so decision-makers can put them back into rotation. Empty rooms provide a good example. Real-time analytics can show which room is empty, how long it’s been empty for, and make a recommendation about which waiting patient might make the most sense to treat in it.

The Future of Real-Time Analytics in Healthcare

With this much power, the use of real-time analytics is sure to gain wider prevalence as hospital leaders catch on to its benefits. Currently, it’s proving most helpful in providing hospital staff with information to help optimize patient flow processes, providing quick, high-impact results. In time, the use of real-time analytics will likely begin to influence decisions within other areas of patient care. For now, think of it as a tool that can be leveraged along with other strategies to optimize operations in your ED.

Meshing Data and People

I briefly touched on this important point earlier — collecting all of this beautiful data and then implementing change based on it are two different steps. But you don’t have to take just my word for it. As Venkat Mocherla, director of business development & marketing at analyticsMD mentioned in a recent blog, “ … to get the most out of big data, you need to be able to work with the people on the ground to bring informed change to life.”

Mocherla was inspired in part by Randy Bean in recent Harvard Business Review blog called, “Just Using Big Data Isn’t Enough Anymore.”

“The vast majority of the challenges companies struggle as they operationalize Big Data are related to people, not technology: issues like organizational alignment, business process and adoption, and change management. Companies must take the long view and recognize that businesses cannot successfully adopt Big Data without cultural change,” says Bean.

Keeping this in mind, if you are investing in big data, I advise that it is worthwhile to also invest in getting a plan together for implementing change based on your learnings. This is because I have seen this challenge crop up at hospitals I’ve worked with in the past.  

If your organization is working to leverage big data to improve operations, I’d love to help. I’ve helped more than one ED create actionable steps and coached staff through the process. I can leverage my 20-plus years of experience to help you optimize patient flow and show you how doing that can lead to increased quality of care and patient satisfaction. Drop me a line at

Even if it isn’t an opportunity for us to work together this important step of creating and implementing an action plan is not one to be missed. You want to maximize the investment you’ve made in data collection. It’s just smart business.

And if you’d like to learn more about how real-time analytics can give your decision makers on the ground information that has the potential to improve patient flow within your ED, visit