Improving Emergency Department flow through optimized bed utilization.

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Emergency Medicine

Background:

• Rising patient volumes in emergency departments (EDs) outpace resource growth at academic tertiary care centers.
• ED congestion leads to prolonged wait times for medically undifferentiated and unstable patients.

Purpose of the Study:

• To halve the 90th percentile wait time (time-to-bed) for high-acuity patients from 120 to 60 minutes.
• To identify and address barriers to optimal patient flow within the ED.

Main Methods:

• Stakeholder engagement to identify flow-interrupting challenges and cultural issues.
• Development of change ideas targeting unnecessary ED bed utilization and communication breakdowns.
• Seven sequential Plan-Do-Study-Act (PDSA) cycles to test interventions.

Main Results:

• Optimization of digital information systems yielded minor gains.
• Implementation of direct communication tools (two-way radios) significantly improved patient flow.
• Post-intervention, 90th percentile time-to-bed decreased from 120 to 66 minutes, showing significant improvement.

Conclusions:

• Enhanced communication strategies, particularly direct contact methods, are crucial for reducing ED wait times.
• Quality improvement initiatives using PDSA cycles can effectively address ED congestion.
• Targeting operational bottlenecks and communication breakdowns improves patient flow for high-acuity individuals.