For years, I’ve had a weekly Google alert that serves up articles on hospital patient flow. About 75% of the articles I get are news stories about packed emergency departments (EDs): patients lined up in on gurneys in hallways, primarily in the U.S., Canada, the United Kingdom, Ireland, Australia, New Zealand and India. These patients are waiting for both treatment as well as admission into the hospital’s inpatient units.
A whole cottage industry of role-blurring activity has risen to support this: inpatient nurses who are flexed down to the ED to take care of patients; hospitalists whose primary role is to care for roomless ED boarders, sometimes for their entire hospital stay; carved-out parking areas in hallways for gurneys where boarding is just a fact of life.
Over the 15 years I’ve worked in this industry, I’ve seen a huge and continued focus on “fixing the ED.” It makes total sense at first glance, given the above. The ED is how most people start their journey through a hospital. Even if you walk into a perfectly functioning emergency department looking for help, chances are you’re already having a bad day. It’s a stressful experience.
There are, of course, many ways to improve ED function: Optimized physical layout, adequate staffing, standard care protocols, and better admission practices are all great ways to ensure good care and increase efficiency. But the problem is that the ED is often examined as a singular unit and not part of the hospital as a whole.
To fully “fix” an ED’s operations, you’ve got to fix how patients are discharged from inpatient units. In other words, to fix the beginning of the process, you have to fix the end of the process. It can seem counterintuitive, but it’s really just a matter of volume. Over 20% of ED patients end up being admitted to inpatient or observation care. ED patients also make up the majority of most hospitals’ inpatient populations. Think of a full egg carton — it holds 12 eggs. If you’d like to add one more, you’ve got to take another one out first. Accelerating discharges is key to freeing up capacity and therefore emptying out the ED.
But how do you know when real emergent action is needed – when a surge is on the way? Not just an influx of patients into the ED, but a confluence of events that means gridlock across the hospital.
eBook: Using Predictive Analytics to Avoid Reactive Surge Management
Most hospitals have surge plans in place that involve complex workflows based on triggering events and tools to help identify problems. But most surge plans and tools don’t fully meet the need. Classic tools like the NEDOCS score are nice indicators of when an ED is overcrowded, but they weren’t designed to help you understand the state of flow inside an entire hospital.
Surge plans are generally one-size-fits-all tools that depend on hard logic. They don’t take into account a hospital’s own history to help communicate when events are truly outside the norm. For example, you might say that “code red” is when a hospital’s med/surg census is over 95%, but what if it’s always over 95%? This just adds to the ineffectiveness of surge plans to those on the ground. It’s another alarm that doesn’t spur action.
Worst of all, by the time someone scrapes together the necessary data and plugs it into an overcrowding algorithm, it’s too late anyway. Staff on the ground already know there’s a problem, and they’re already taking action. It’s like having a storm warning pop up after the tornado just took Dorothy to Oz.
The problem here lies in not knowing in advance when a surge is going to happen, and not tailoring that advance warning to a hospital’s own historical ebbs and flows. The good news is that the technology now exists to look across the whole of a hospital’s operations and provide appropriate warning.
A truly strong surge warning includes:
- Forecasts of ED and surgical boarders, incorporating inpatient movement and discharge to understand when boarding will be a major issue
- Suggestions on which inpatients to discharge, based on patient readiness and impact to the hospital, in order to free the best possible amount of capacity
- A focus on identifying conditions truly outside the norm for a hospital, not just statically set logic
- Appropriate communication to the right parties at the right time
Hospital IQ’s predictive and communications capabilities allow you to move beyond static, unchanging rules and understand not just when things are busy at your hospital, but when things will be truly busy, and what you can do to stop a surge before it begins.
For a deeper dive into surge management, check out my latest episode on the Hospital IQ podcast: