Guest commentary by Janie Schumaker, RN, MBA, CEN, CPHQ
Emergency physicians are seeing a rising tide of patients coming through the ED.

That’s the conclusion of a recent poll by the American College of Emergency Physicians, which found that more than 80 percent of emergency physicians said patient visits are increasing in their departments, with more than 90 percent expecting higher volumes next year.
The survey confirms what we are already witnessing in EDs across the nation: Visits are going nowhere but up -- especially with the nation’s growing primary care physician shortage, aging population and healthcare reform.
So how can providers meet the growing demand for ED services at a time when budgets are tight and adding capacity isn’t usually an option? Here are a few suggestions:
1) Understand the flow. Are patients clustering at the front door? Are beds being turned too slowly? Before addressing efficiency problems, cutting waste and streamlining workflows, or even adding beds, ask tough questions and study the flow of patients through the ED to understand where bottlenecks are occurring and what is causing them.
2) Get creative. With increasing patient volumes, EDs cannot afford to do things as they have always done. In many hospitals, the triage nurse does a comprehensive assessment by collecting a massive amount of data from the patient as part of the intake process. By streamlining processes like these and implementing automated systems, door-to-doc times and patient throughput can be accelerated.
3) Choose the right EHR. Hospitals need to equip clinicians with best-of-breed EHRs that are easy to use and intuitively designed based on the ED’s specific needs. Otherwise, significant dips in productivity are sure to follow.
4) Keep score. Emergency physicians need to work closely with nurse leadership to create quality scorecards that track measurable performance against ED goals and become a springboard for regular discussions with hospital administrators.
5) Remember that the ED is the most important place in your hospital. Period. Hospitals administrators must ensure the ED gets top priority when turning around lab and radiology tests to improve patient throughput and reduce LOS, and they need to put the ED front and center of their facility’s overall strategic plans. After all, approximately 45 percent of hospital revenues come from patients admitted through the ED, according to the National Health Statistics Reports.
As patient volumes skyrocket and pay-for-performance models become reality, providers that fail to act to improve overall ED efficiency and throughput are sure to suffer declining patient satisfaction scores, growing safety issues, dwindling market share and lower reimbursement.
Janie Schumaker, RN, MBA, CEN, CPHQ, manages the Center for Performance Excellence at T-System, Inc.