Understanding the challenges in the ED is key

Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School, is a global front-runner in improving patient flow.

Key solutions are patient data tracking, evidence-based protocols, medical informatics and cross-departmental collaboration. Taking its own medicine, the hospital has improved the rate of heart attack patients that meet the national treatment target from 53% to 86%.

Spending an afternoon in the company of MD and Assistant Professor at Harvard Medical School Philip Anderson, who works at the department of emergency medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts it becomes clear that there is no single way to solve the challenges hospital staff face in striving for optimal patient flow in emergency departments. However, he readily points towards a number of tools that can help improve patient flow:

"To overcome crowding, emergency departments must have highly skilled staff with uniform training in Emergency Medicine. That brings standardisation to knowledge and skills, which improves effectiveness. These standardised work processes should ideally be translated into evidence-based protocols that ensure patients with similar symptoms get the same treatment independently of time, place or health care provider", says Assistant Professor Philip Anderson.

Real-time data tracking

Another important measure is patient data tracking. Many hospitals have already introduced electronic medical records that give hospital staff access to patients’ medical history. But to improve patient flow further, the patient data tracking should incorporate real-time data:

"If test results such as lab data and imaging data are immediately available through the patient data tracking system, hospital staff will win valuable time, which can improve patient flow and ultimately save lives", Dr. Anderson accentuates.

To keep momentum, emergency departments can also benefit from efficient Point-Of-Care testing that is designed specifically with the challenges of emergency departments in mind:

"Medical informatics is a breakthrough in medical practice, but the informatic tools must meet the specific needs of emergency rooms. This means that tests should fill information deficits, but without overwhelming staff with information – which will make decision-making more difficult", the Assistant Professor explains and adds that P.O.C. test results increase the speed and efficiency of the patient data tracking.

Multi-disciplinary task force improves patient flow

Patient flow is everything to the emergency department, which cannot, however, solve the task on its own. Therefore several departments were involved when the emergency department at Beth Israel Deaconess Medical Center discovered that only 53% of patients coming in with ST segment elevation myocardial infarction (STEMI) – which is the more severe type of heart attack and caused by a blood clot completely blocking a coronary artery – received full treatment as fast as the national target requires:

"The US national target dictates that at least 75% of STEMI patients should have a door-to-balloon interval that is less than 90 minutes. This means that within 90 minutes, from the time the patient arrives at the emergency department, the patient must be under treatment in the cardiology department. To get patients through the system faster and meet the national target we had to involve nurses, doctors, interventional cardiologists and other staff groups", says Dr. Anderson, who emphasises that collaboration across departments was just one of more elements in the process.

The task force also employed an electronic group paging system, which alerted all team members wherever they where, whenever a STEMI patient was identified in the emergency room. Further, decision-making was placed with the senior physician in the emergency department. And today the result speak for itself:

"We have improved the percentage of patients meeting the target from 53% to 86%. That is a 33% absolute improvement and a relative improvement of over 60%."

Identify the right audience

He also points out that there is a need for technology that can relieve bottlenecks in emergency rooms. But to succeed, technology providers must understand the needs, work processes and challenges of emergency departments and also they must understand the acquisition policies of the hospitals:

"It is important to talk to the right audience. Physicians in the emergency department might be interested in POC testing but may not have decision-making authority for major capital acquisitions. Especially at larger hospitals it may be important to include hospital administration and laboratory medicine in the discussion", says Philip Anderson.