As the value proposition in health care takes hold, hospital leaders should rethink the role of the emergency department (ED) in meeting the patient’s comprehensive care needs. Here, Shari Welch, MD, FACHE, an author, consultant, and researcher at the Intermountain Institute for Healthcare Delivery Research, offers five ways for increasing ED value.


Polish your ED image. According to the 2012 data report from the Emergency Department Benchmarking Alliance, 67 percent of hospitalized patients are admitted through the ED, meaning the ED is often the patient’s first impression of a hospital. The problem is that most EDs are noisy, messy, and dreary. To create a better patient experience, Welch says hospitals should install sound-absorbing materials, keep areas clean, and regularly fix or freshen up furnishings and finishes that have become worn out. “See the ED as the front door to your hospital,” Welch says. 

Create specialized ED service lines. In the traditional ED, services are provided in the same way for all patients, no matter their age or needs. Instead, Welch advises leaders, “Design your services and your patient flow according to the patient population you serve.” For example, if the ED has a large population of senior citizens, design a geriatric ED or offer specialized senior services within the ED. Providing targeted supplies, medication, and staffing in specific areas of the ED can speed up the delivery process, thereby improving efficiency and quality of care, Welch says.

Know your numbers. Hospitals may not be able to predict when patient volume will surge due to a catastrophic event, but by using internal data, hospitals can predict patient volume for an average weeknight or weekend, the number of X-rays that will be used, and how many patients will be admitted. Knowing these numbers will help hospitals fine tune both staffing and operations to improve ED throughput, Welch says. 

Use your ED resources in new ways. Most EDs have mechanisms in place to answer health questions from patients by phone (e.g., Ask a Nurse programs) and services for low-acuity patients (e.g., Fast Tracks). By flipping the paradigm, ED nurses can reach out to discharged patients to ensure they are taking medications and receiving follow-up care. “We know that this kind of service can prevent readmissions,” Welch says. 

In addition, the Fast Track area can be used for routine checkups for patients who have been unable to schedule follow-up appointments with their primary care physicians. “We have to take a broader view of ED services as a place for unscheduled care,” she says.

Educate. The idea that EDs should provide only emergent/urgent care is out of date, Welch says. Most ED visits last hours, while the time actually spent with a physician may be measured in minutes. Using that time to educate the asthmatic or diabetic patient about the importance of healthy behaviors (such as smoking cessation
and weight control) can aid in overall health maintenance. “In this emerging vision for health care, EDs need to act like a part of the broader system and work toward health management for the patient,” she says.  

Karen Wagner is a freelance writer, health care, Forest Lake, Ill.  

Publication Date: Tuesday, April 01, 2014

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