Improving Emergency Department Throughput and Cycle Time at Safety Net Hospitals

Public and other safety net hospitals, including members of the National Association of Public Hospitals and Health Systems (NAPH), provide nearly three times more emergency department (ED) visits than other acute care hospitals nationally. Therefore, effective throughput is critical to reducing ED overcrowding and ensuring that each patient receives timely, high-quality care. In partnership with the University HealthSystem Consortium (UHC), the National Public Health and Hospitals Institute (NPHHI) adapted UHC's 2006 benchmarking study, “Managing Patient Flow in the Emergency Department and Operating Room,” for safety net hospitals. NPHHI administered the survey to NAPH member hospitals and interviewed high performers (i.e., those scoring in the top 25 percentile on key metrics, including length of stay and time to admittance) to identify their most effective patient flow strategies. Chi Square analyses were conducted using PASW/SPSSv.18.

High performance in ED throughput was correlated with: • Having Trauma Level I certification (p=0.042); • Having an above-median number of ED treatment spaces (p=0.012); and • Having an above-median number of nurses for each shift (p=0.012).

Strategies to improve ED throughput include: • Creating a rapid assessment process; • Increasing the numbers of staff; and • Creating an inpatient overflow area.

The findings suggest that implementing the strategies used by top performing hospitals can increase ED efficiency and patient flow.