Strategies to manage growing ED volumes, per 3 leaders

Leaders at high-volume emergency departments are finding new ways to handle capacity issues while reducing wait times.

Nilesh Patel, DO, chair of emergency medicine at Patterson, N.J.-based St. Joseph's University Medical Center, which had 150,615 visits in 2019, told Becker's there is no easy answer to handling increased volumes but shared strategies his system has found effective.

"Strategies that we have incorporated include dynamic scheduling so that we increase our staff for predictably busier days and decrease on lighter days; enhancing our triage model so that patients are assessed and treated more quickly; and working with leaders throughout the organization to decrease overall length of inpatient stays," he said. 

Like many hospitals, St. Joseph's is also increasing recruitment and retention efforts.

Jimmy Lao, MSN, RN, director of nursing for Reno, Nev.-based Renown Regional's emergency department, which is on track to reach 110,000 ED visits this year, is taking a different approach to staff shortages. The system is transitioning non-certified emergency department technicians into EMT techs. After helping them obtain their EMT certification, "We build a scope of practice for them, including assessment and medication administration, which augments the skill set of our nurses."

Having more technicians allows patients to move more quickly through the department. 

"It's how we were able to decrease our wait times," Mr. Lao said. "We've been able to make patients' experiences better while waiting. When waiting in a single location, the perception is, 'I'm just waiting here and not doing anything' versus moving forward in the process."

Renown has embraced the split flow model — in which low-acuity patients go to certain areas while high-acuity patients go to the core area of the emergency department. Low-acuity patients are taken through a moving process that takes them from one room or waiting area to the next. This process, Mr. Lao said, minimizes wait times and allows for quicker discharges.

Jeffery Metzger, MD, chief of emergency services at Dallas-based Parkland Health, which had 210,152 ED visits in 2019, told Becker's his health system also tries to move patients from one area to another as quickly as possible. When capacity reaches a "critical level," patients will be doubled up in rooms. In some cases, patients who are waiting for a bed will be moved from the waiting room to the hallway while they wait, and in cases where patients are waiting on a ride or for similar reasons, they will be moved to a discharge waiting area in order to free up the bed.

Dr. Metzger and Mr. Lao said the most important strategy for dealing with emergency department capacity issues is collaboration both inside and outside the hospital.

"Our success is based on our relationships that we built over the last few years," Mr. Lao said. He pointed to leader rounding as a key place to improve operational efficiency. "They have constraints that we can definitely fix and we have constraints they can fix, so that mutual understanding and relationship allows us to make adjustments."

Dr. Metzger advised hospitals to also seek advice from other systems:

"There are groups of leaders on both the physician and nursing side that get together and talk about our big issues. We share what things we've done on an individual hospital level to try to fix those issues and what things on a county, state, or national level needs to be done."

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