Hospital emergency departments (EDs) are a critical component of our health care system, offering the only guaranteed source of healthcare available 24 hours a day, 365 days a year. As ED use in California continues to rise on a per capita basis, there are long waits for treatment, especially in low-income areas where there is a scarcity of providers and urgent care centers.
This results in patients leaving the ED without being seen or treated. Kaiser Health News reported in May 2019 that the percentage of patients who left the ER after being seen by a doctor, but before their medical care was complete, increased by almost 60% between 2012 and 2017. Patients with complex care needs who have been admitted to the hospital often languish in the ED waiting for an inpatient bed, which has been shown to increase their risk of adverse outcomes, medical errors and mortality. According to the Kaiser Health News ED data analysis, California emergency room wait times remain higher than the national average, and only four states have a longer median wait time.
Many EDs have implemented best practices to address the flow of patients within the ED. Few hospitals have mastered facility-wide changes to systemically solve the problem. The cost and complexity of such initiatives can be perceived as beyond the capacity of finacially stressed institutions serving poor and disadvantaged patients. Improving efficiency and throughput in the ED should improve patient outcomes and satisfaction while also enhancing hospital financial performance.
A new report from the Institute for Medical Quality (IMQ) funded by the W. M. Keck Foundation has demonstrated that three safety net hospitals in the Los angeles area successfully used lean process improvement to reduce ED length of stay and/or reduce inpatient discharge times, freeing up beds for ED patients. In addition, all three hospitals found that reducing ED length of stay would enhance financial performance primarily by reducing the number of patients who elope before being admitted for inpatient care and the time the ED diverted ambulances to other hospitals.
This project also found that issues such as lack of timely access to data, analytical capacity and staff incentives slowed the hospitals' progress. Health systems that want to improve patient outcomes and their financial performance should provide their hospitals with the leadership and resources they need to prioritize lean process improvements.
See the full report here
Staff Contact: Juli Portola 415.882.5151