Academic journal article Journal of Healthcare Management

Data-Driven Process and Operational Improvement in the Emergency Department: The ED Dashboard and Reporting Application

Academic journal article Journal of Healthcare Management

Data-Driven Process and Operational Improvement in the Emergency Department: The ED Dashboard and Reporting Application

Article excerpt

Suzanne Stone-Griffith, RN, MSN, CNAA, assistant vice president of emergency services, Clinical Services Group, HCA; Jane D. Englebright, PhD, RN, chief nursing officer and vice president, Clinical Services Group, HCA; Dickson Cheung, MD, MBA, MPH, attending physician, Sky Ridge Medical Center, Carepoint, PC; Kimberty M. Korwek, PhD, medical writer, Clinical Services Group, HCA; and Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI, chief medical officer and president, Clinical Services Group, HCA

EXECUTIVE SUMMARY

Emergency departments (EDs) in the United States are expected to provide consistent, high-quality care to patients. Unfortunately, EDs are encumbered by problems associated with the demand for services and the limitations of current resources, such as overcrowding, long wait times, and operational inefficiencies. While increasing the effectiveness and efficiency of emergency care would improve both access and quality of patient care, coordinated improvement efforts have been hindered by a lack of timely access to data.

The ED Dashboard and Reporting Application was developed to support data-driven process improvement projects. It incorporated standard definitions of metrics, a data repository, and near real-time analysis capabilities. This helped acute care hospitals in a large healthcare system evaluate and target individual improvement projects in accordance with corporate goals. Subsequently, there was a decrease in "arrival to greet" time-the time from patient arrival to physician contact-from an average of 51 minutes in 2007 to the goal level of less than 35 minutes by 2010.

The ED Dashboard and Reporting Application has also contributed to data-driven improvements in length of stay and other measures of ED efficiency and care quality. Between January 2007 and December 2010, overall length of stay decreased 10.5 percent while annual visit volume increased 13.6 percent. Thus, investing in the development and implementation of a system for ED data capture, storage, and analysis has supported operational management decisions, gains in ED efficiency, and ultimately improvements in patient care.

For more information about the concepts in this article, please contact Dr. Perlin at jonathan.perlin@hcahealthcare.com.

"HCA," "Company," "we," "our" or "us," as used herein refers to HCA Inc. and its affiliates unless otherwise stated or indicated by context.

INTRODUCTION

Emergency departments are critical to the delivery of healthcare for Americans. EDs have long been the destination of choice for acute medical conditions such as major trauma, strokes, and heart attacks, and they are increasingly the entry point for patients, handling nearly 50 percent of hospital admissions (Elixhauser and Owens 2006; Owens and Elixhauser 2006). In addition, EDs continue to serve as a safety net for millions of Americans. Between 1996 and 2006, annual ED visits increased 32 percent, reaching approximately 120 million visits, yet the number of hospital EDs decreased nearly 5 percent (Pitts et al. 2008). This has placed an enormous strain on the capacity resources of EDs. Reports of ED crowding are increasing, as are the associated negative consequences, such as ambulance diversion, prolonged patient wait times, increased patient complaints, decreased staff satisfaction, decreased physician productivity, and suboptimal clinical outcomes (Derlei and Richards 2000; Richards, Navarro, and Derlei 2000; Liu, Hobgood, and Brice 2003; Eckstein and Chan 2004; Richardson 2006; Pines and Hollander 2008; Pines et al. 2008).

While reducing crowding could alleviate these negative consequences, simply adding capacity to meet demand is not feasible for mosl facilities. Accordingly, there have been serious calls to increase lhe effectiveness and efficiency of emergency care (CFEC/BHCS/IOM 2007). Mosl improvemenl efforts have focused on the creation and implementation of a series of projects wilh a specific lhroughpul focus (eg. …

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