Hospitals across the U.S. have struggled with high patient loads. The South led the nation, along with Washington, D.C., a few weeks ago in the number of flu cases.
“That’s come down somewhat as other areas catch up, but it has put enormous pressure on emergency departments,” Robert Hart, MD, chief physician executive at New Orleans-based Ochsner Health, told Becker’s.
Ochsner started working to improve ED flow in the last quarter of 2024, and the system has been put to the test during the high flu season. However, it has cut diversion hours by 90% across the system and also reduced ED patient referrals from its on-call triage system. Dr. Hart credited the success to taking a holistic view of patient flow.
“For years, I think we were looking at ED throughput too narrowly — focusing on individual steps rather than the whole system,” he said. “Now that we’re approaching it holistically, I believe we’re on the path to real, sustainable change. The ED is the front door to the entire hospital, and bottlenecks anywhere in the system affect patient flow.”
The system’s three-prong approach includes preventing unnecessary ED visits, finding new ways to move patients efficiently through care once they enter the ED and discharging them quickly either to their home or to hospital care.
“By categorizing the problem this way, we could target each phase of the process separately, rather than tackling it all at once,” Dr. Hart said.
To prevent unnecessary visits, Ochsner has virtual ED physicians handle incoming patient calls from an on-call triage system asking for medical advice. Instead of recommending hospital visits, physicians evaluate the patients to determine the appropriate level of care. In the first two months of implementation, the system reduced patient visits from these calls by 70%.
To improve flow within the hospital, Ochsner has created nine drive teams that analyze different aspects of the hospital flow and implement solutions. Most importantly, Dr. Hart said it moved away from thinking of flow as a need to get ED physicians and hospitalists to admit patients more quickly.
“It’s so much bigger than that,” he said. “It’s a symphony, where every piece must work together. You can’t fix one element and expect everything to improve.”
The team found that many delays had nothing to do with physicians. It was ensuring the lab team was staffed and ready to run tests quickly, that transport teams were available to move patients without delays and that rooms were cleaned quickly to make beds available faster. The system also worked to distribute patients across all its hospitals and easing the burden off Ochsner Medical Center in New Orleans or Ochsner Lafayette General, which tend to have the highest patient loads. The system also worked to identify discharge barriers early and assign case managers to patients as soon as they entered the ED.
Before making changes, across all of its facilities, Ochsner had about 12,000 to 13,000 hours of diversion in each of the first three quarters of the year. In the last quarter of 2024, diversions were cut down to 1,200 to 1,300 — a 90% reduction.
“We did this by committing to managing patient flow better rather than diverting patients elsewhere,” Dr. Hart said.
To address discharge bottlenecks, Ochsner is opening more post-acute beds and tracking how long it takes for patients to receive X-ray, lab results and transport services.
“Every delay contributes to longer ED stays,” he said.
