Improving an emergency department’s (ED) timeliness of care, quality of care, and operational efficiency while reducing avoidable readmissions, is fraught with difficulties, which arise from complexity and uncertainty. A recent CHOT study describes an ED decision support system that allows healthcare administrators to optimize workflow globally, taking into account the uncertainties of incoming patient diseases and associated care, thereby significantly reducing the length of stay (by 33% in the study hospital) and waiting time of patients (by 70%). This system couples machine learning, stimulation, and optimization to address these complex challenges. Using this system offers significant advantages in that it permits a comprehensive analysis of the entire patient flow from registration to discharge, enables a decision maker to understand the complexities and interdependencies of individual steps in the process sequence, and ultimately allows the users to perform system optimization. Overall benefits and impacts include improved timeliness of care, improved efficiency and emergency care, annual financial savings and revenues, encouragement of external sponsorship; health cost reductions, and improved quality of care in other facilities. It has been used successfully since 2010.
The quality of care impacts include 30% reduction of length of stay, and 70% of the associated average waiting time; 28% reduction in ED readmissions; 32% re-direct of non-urgent-care cases; 19% increase in ED throughput; and 30% reduction of patients who left-without-being-seen. The “golden hours of treatment” for trauma patients was reduced by 10%. The ED efficiencies at Grady led to a 10% reduction in ED-to-hospital admissions.
The financial impacts of the ED efficiencies at Grady include a $7.5 million yearly savings in penalties due to a reduction in revisits. The alternative care facility for non-urgent conditions reduces ED costs by $21.6 million and results in $12.5 million in revenue. Expansion of trauma care and efficiency results in $19.1 million in revenue; the reduction in left-without-being-seen patients leads to $96.6 million in revenue. For a critical safety-net hospital with $1.5 billion of annual economic impact, only 8% of which results from private insurance, these financial gains have a tremendous impact on maintaining financial healthiness.
Lee, E. K., Atallah, H. Y., Wright, M. D., Post, E. T., Thomas IV, C., Wu, D. T., & Haley Jr, L. L. (2015). Transforming Hospital Emergency Department Workflow and Patient Care. Interfaces.
Eva Lee, PhD