How to Improve the Performance of Your Emergency Department

by | Oct 23, 2019 | Healthcare

Reading Time: 5 minutes

The health of a hospital’s emergency department is critically important, as it is the first line of care for many acute patients. How do you treat your patients in their time of need? Are you able to move them through the hospital quickly and efficiently? How do you make sure your staff stays engaged and motivated?

There are many initiatives hospitals can undertake to ensure optimal performance of their emergency departments. Let’s take a look.

Emergency department statistics

According to the Centers for Disease Control, 145.6 million people visit a hospital emergency department each year.

  • 39% of patients are seen in fewer than 15 minutes
  • 7% of visits result in a hospital admission
  • 7% of visits result in a transfer to a different hospital (such as a psychiatric institution)

How long do patients typically spend in the ED? For patients who are sent home after their visit, they spend nearly 3 hours in the ED (172 minutes – up from 140 minutes in 2016). Patients who are admitted spend more than 5.5 hours in the ED before being moved to the hospital (334 minutes vs. 279 minutes in 2016).

Why are these numbers going up? And how can we reverse this trend? Part of it has to do with staffing. The other part has to do with operational flow. Let’s examine.

Having an engaged emergency department staff

During an educational event titled, “Excellence in the Emergency Department,” presented by the Massachusetts Health & Hospital Association, Stephanie Baker and Dan Smith of Studer Group talked about some of the staffing challenges healthcare organizations face in their emergency departments.

Smith talked about how in 1973, fewer than 15% of physicians expressed doubt about entering the medical field. Today, 30% to 40% of physicians question their career choice. Emergency medicine is one of the highest areas of physician dissatisfaction, with 53% reporting feeling burned out.

Add to this that there are currently provider shortages, and many nursing staff are baby boomers and planning to retire.

Smith and Baker talked about the importance of hospitals working to have a more engaged workforce. The benefits of a more engaged workforce are:

  • Improved loyalty and patient experience
  • Increased market share
  • Decreased litigation
  • Improved provider recruitment and retention
  • Improved safety and quality outcomes
  • Improved measures on national metrics

To improve employee engagement, Smith and Baker recommend “rounding” – but different from what you would normally expect in healthcare. In this type of rounding, managers meet with health professionals on a regular basis to provide feedback on what they are doing well in their jobs and provide coaching to help them improve. This helps employees connect to their purpose.

In addition, they recommend taking the time to recognize colleagues who do good work, and to do so with a written note. This is much more effective than a verbal recognition, as it shows you took the time to sit and think about someone’s accomplishment.

Improving operational flow is key to improving care

It’s also important to consider patient flow through an emergency department and figure out how to optimize it. There are six areas to consider when aiming to improve operational flow, according to Smith. They are:

  1. Triage: How can triage adjust to ebbs and flows with patients coming in?
  2. Variation: How can a similar volume on two days feel so different?
  3. Provider: What would be the impact of adding another provider?
  4. Design: What is the ideal design so patients flow through optimally?
  5. Culture: How urgent does the team feel in moving patients through?
  6. Communication: How are we communicating with patients so they don’t feel lost?

Moving patients through an ED effectively not only improves the quality of patient care, but it also improves patient safety and patient satisfaction.

There is also the fiscal case to make for flow efficiency. Reducing throughput by one hour for a hospital with 30,000 ED visits per year would free up time, meaning the hospital could then accommodate new visits. Those new visits could result in more than $5 million in revenue for a hospital. In addition, reducing the number of walkaways by 1% could result in more than $100,000 in new hospital revenue.

Using analytics to optimize emergency department throughput

When analyzing throughput, it’s important to examine “people, process, and technology.” Are your people engaged? Are they working efficiently? Is the design of your ED optimized? And what technology can help. Analytics can play a role here.

With analytics, hospitals can examine throughput and identify where there are bottlenecks in the flow. For example, is it during the triage process? Do you need to add another triage nurse? Is it in the time until someone sees a provider? Or is it in the time to admit/discharge? Once you see where the lag time is, you can work to address that.

Here are a couple of examples of healthcare organizations that have successfully addressed throughput challenges through analytics:

  • Henry Mayo Newhall Memorial Hospital: This hospital, based in Valencia, Calif. was able to see an 80% decrease in its door-to-triage time, a 60% decrease in triage-to-room time, and a 63% decrease in room-to-physician time by using analytics to examine its throughput. Read more about Henry Mayo’s experience here.
  • Huangshi Central Hospital: This hospital, based in Hubei Province, China, used analytics to track the flow of cardiac patients through its hospital. As a result, the hospital was able to decrease its door-to-balloon time by 40% and reduce its cardiac patient mortality rate by 67%. Read more about Huangshi Central Hospital here.


Hospital emergency department wait times are increasing, and it’s having a harmful effect on the health of patients, the well-being of providers, and the financial success of hospitals.

Improving throughput is a complex process that requires assessing the culture of an organization and the processes by which it operates. Analytics can play a strong role in examining throughput and identifying bottlenecks, resulting in quantifiable improvements in a hospital’s finances, and, most importantly, patient care.

Kathy Sucich
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