Better decisions in the emergency department

Better Decisions in the Emergency Department

How a major hospital in Florida, United States, reduced Door-to-Provider time by 46%, optimized staffing levels, and shortened length of stay

Whether it’s called gridlock or overcrowding, emergency departments across the country are looking for ways to serve a growing number of patients each day, safely and efficiently. At this hospital, the impact of rising emergency department (ED) visits was assessed by building an accurate computer-based model of the department. The model, created using one of EYF’s digital planning solutions, made it possible to test three key “what-if” scenarios and understand the impact of potential changes.

Faster care for lower-acuity patients

What would happen if lower-acuity patients were treated in a separate unit? The Rapid Care Unit (RCU) was designed for exactly that. This dedicated unit has a streamlined process, enabling a physician-led team to treat more patients without compromising quality of care, while freeing up bed capacity elsewhere for more severe cases. That’s the theory, at least. The only way to be truly confident is to validate how well the unit performs within the department as a whole.

The hospital incorporated the RCU scenario into the model to compare it against real data and real-world variability. The results showed that lower-acuity patients treated in the RCU could see an 8% reduction in Door-to-Provider time and a 27% reduction in Length of Stay.

A better approach to triage

What would happen if a physician participated in triage? It sounds like an obvious win, but this change can sometimes slow triage down or create staffing challenges. Under a proposed Rapid Evaluation (REV) approach, a physician would assess the patient earlier and initiate orders and clinical actions sooner. The hospital tested this scenario in the model and observed a 46% reduction in Door-to-Provider time. It was also identified that the back end of the process experienced a slight impact without additional resources, helping avoid unwanted downstream effects later on.

Smarter staffing decisions

What’s the best staffing plan? It’s the golden question everyone wants answered. The hospital used the model to address it. First, data from the ED census and the nurse-to-patient ratio were collected to define optimal staffing levels for each hour. This information was incorporated into the model, and the solution’s visual dashboard was used to continuously validate the impact on critical patient care metrics. The hospital also evaluated and presented multiple staffing scenarios to meet different budget constraints.

Improving Door-to-Provider time was a key priority, so REV, and its 46% reduction in this core metric, represented a major win for the department. As a result of the study, the hospital implemented the RCU on a permanent basis, is in the process of implementing REV, and successfully added staff to the emergency department.