Strategies Using Data Analytics Have Proven Successful
Boarding, or keeping patients in an Emergency Department (ED) while waiting for an inpatient bed, is unfortunately widespread. According to the Centers for Disease Control and Prevention, in 2016, two-thirds of hospitals reported boarding patients in the ED or an observation unit for more than two hours, compared with 57% in 2009. Considering the adverse effects of boarding, it’s important to develop possible solutions, including reducing ED crowding by using advanced performance analytics.
What causes boarding?
Several causes are typically cited, including:
- A high volume of patients being admitted
- Staffing optimization (when demand outstrips capacity)
- Bed/resource availability in the hospital (not the ED)
- Poor patient throughput (including poor discharge planning)
Regardless of capacity, many services — including medical procedures, diagnostic testing, and specialist consultations – are often contributing factors for poor patient throughput, especially if they are not always available 24/7. Another source of inefficiency is when staffing is not optimized based on demand, especially during nights and weekends — one study found that patients were half as likely to be discharged on weekends and holidays than on other days.
Improving Patient Throughput
Reducing patient boarding time to less than the national average of 109 minutes can lead to reduced walkaway rates and higher admission rates, increasing revenue and patient satisfaction. One hospital found that moving admitted patients to inpatient beds within two hours increased the “functional treatment capacity” of its ED by 10,397 hours, or 433 days, annually.
Strategies that optimize bed management reduce boarding by improving patient flow. Smoothing out surgical scheduling, simplifying admission protocols, and streamlining discharges are just a few strategies that have been successful in curtailing ER boarding.
Smoothing out surgical scheduling: Harvard Medical School published a study conducted at Children’s Hospital in Boston that found that during the hospital’s busiest times, when elective surgery peaked, so did the number of patients diverted from the ICU. Distributing surgical procedures evenly over the week has been shown to dramatically decrease ED boarding at Boston Medical Center, for instance. It decreased peaks in demand for inpatient beds and the need for procedure cancellations due to overbooking, easing capacity crunches and allowing surgeons to perform more surgeries. Putting a limit on daily surgeries and distributing procedures more evenly during the week has decreased the amount of time ED patients waited for an inpatient bed from about 3 hours to about 2 hours, 10 minutes.
Simplifying admission protocols: Research has indicated that simplifying procedures speeds up the transfer of patients to the floor. Steps could include standardizing care for diagnosing cases and using technology to decrease variation and avoid delays.
A study conducted at University of Texas Southwestern Medical Center examined existing admission processes and developed an intervention that focused on a change in management architecture, “narrowing clinical roles, mandating direct communication, establishing clear boundaries for patient responsibility and instituting carefully constructed holding orders.” The streamlined admission process had 10 steps (down from 50) and saved 27,884 hours, or 1,161 ED patient-days, over the course of one year.
Streamlining discharges: Strategies to expedite inpatient discharges include planning from time of admission for home services, transportation, care follow-up, etc., as well as efficient nursing care coordination and communication with physicians.
According to a report by the Agency for Healthcare Research and Quality for the U.S. Department of Health and Human Services, other helpful, tested interventions include patient education, ED-made appointments, and prescription assistance. More and more hospitals are using a discharge lounge, a gathering place for patients and their families who are waiting for discharge or for rides.
Reduce Boarding by Reducing Crowding
Rather than chasing symptoms of ED crowding, d2i’s Performance Dashboard can provide the detailed information needed for root cause analysis to enable high impact actions. For instance, d2i’s Census and Arrivals report provides an hourly average census grouped by acuity level, area of the ED, and status of service. Comparing this to the number of available treatment spaces allows you to assess total hours over capacity, the percentage of hours above capacity, and more.
Are you looking for a way to reduce crowding and increase performance in your ED? See why no other health care business intelligence tool or EHR system even comes close to d2i’s. Contact us to learn more about how we can help your department reduce boarding, or to schedule a 30-minute demo.