Bursting at the Seams: Improving Patient Flow to Help America's Emergency Departments

Publication Date: September 2004

Publisher: Robert Wood Johnson Foundation

Author(s): Urgent Matters

Research Area: Health

Type: Report

Abstract:

Across America, hospital emergency departments (EDs) are in crisis as they are overwhelmed with rising numbers of patients. The number of ED visits increased by 23 percent from 1992-2002, while the number of EDs decreased 15 percent during same time period, according to the CDC. Ten hospitals participating in the Robert Wood Johnson Foundation initiative Urgent Matters, have been able to decompress their EDs by making a commitment to address issues of patient flow using a hospital-wide approach. These hospitals worked together in a year-long Learning Network. Using formal quality improvement methods, the hospitals developed and tested strategies to reduce patient flow bottlenecks in the ED, within various inpatient units and across the hospital. They also received expert assistance in developing "best practices." Numerous strategies were implemented with the goals of making sure patients received timely, high-quality care. With the Urgent Matters web-based management system, hospitals could track their progress by collecting and charting data for 17 key performance indicators. This data was shared between the hospitals, ensuring transparency and a spirit of collaboration. All of the hospitals achieved significant improvement with most making dramatic measurable progress. For example, one hospital reduced its average total ED throughput time from 7.0 hours to 5.25 hours, while another hospital reduced the time that a patient in the ED waits for an inpatient bed from 16 hours to one hour. In an era when hospitals nationwide are being forced to do more with less, finding strategies to improve patient flow has become more critical than ever. The Urgent Matters hospitals have demonstrated that change is possible.