Urgent Matters Forum Addresses Patient Flow Issues

Six-hospital initiative is field-testing strategiesto improve patient flow, reduce crowding in EDs.

June 2010

By Linda Blachly
ACEP News Contributing Writer

Hospital leaders, researchers, physicians, and emergency medicine experts from across the country met in Washington to discuss critical findings in a recent study on improving patient flow in emergency departments.

The American College of Emergency Physicians has advocated at the national and state levels to improve quality and patient care in emergency departments. ACEP President-elect Sandra M. Schneider, M.D., and ACEP staff participated in the April 30 event.

The forum revealed groundbreaking data from the report "Urgent Matters Learning Network II Initiative to Improve Hospital Patient Flow and Reduce Emergency Department Crowding," and it came at a crucial time, as the nation's health care system moves into the spotlight to provide quality health care for everyone. ACEP has been working closely with the Obama administration to develop quality measures that address the practice of boarding in emergency departments, "an institutional problem that has a significant negative effect on patient safety, comfort, and satisfaction," Dr. Schneider noted.

"As more than 32 million Americans get health care coverage, our current emergency departments won't be able to safely handle the surging demand without addressing critical patient flow issues," said Bruce Siegel, M.D., M.P.H., an emergency physician and director of Urgent Matters and the Robert Wood Johnson Foundation's Aligning Forces for Quality initiative.

"Against a backdrop of national health reform and increased accountability, now more than ever, hospital EDs need to study their care processes and act in order to establish a safe, high-flow environment," Dr. Siegel explained in the report.

On the front line of efforts to improve the nation's emergency departments is the Urgent Matters Learning Network II, a collaborative of six hospitals nationwide to identify, develop, and implement strategies to improve patient flow and reduce crowding during an 18-month period.

This initiative is the nation's first field-test of standard performance. The Robert Wood Johnson Foundation is funding it, with management by Dr. Siegel and the Urgent Matters team at the Center for Health Care Quality at the George Washington University Medical Center, Washington.

This effort has three key goals:

  1. Rigorously evaluate the implementation of strategies for improving patient flow and reduce emergency department crowding within the context of a hospital learning network;
  2. Advance the development of standard performance measurement in the emergency department; and
  3. Promote the spread of promising practices to a wider audience and variety of hospitals.

The six participating hospitals are Good Samaritan Hospital Medical Center, Long Island, N.Y.; Hahnemann University Hospital, Philadelphia; Stony Brook University Medical Center, Stony Brook, N.Y.; St. Francis Hospital, Indianapolis; Thomas Jefferson University Hospital, Philadelphia; and Westmoreland Hospital, Greensburg, Pa.

During the forum, Susan Dentzer, editor-in-chief of Health Affairs, led a discussion about the report findings with John Lumpkin, M.D., M.P.H., an emergency physician and senior vice president and director of the Health Care Group, Robert Wood Johnson Foundation; Mark McClelland, R.N., M.N., C.C.M., C.H.P.N., assistant director for quality improvement, Urgent Matters; Vickie Sears, M.S., R.N., C.C.R.N., C.P.H.Q., assistant director for quality improvement, Urgent Matters; Jesse Pines, M.D., M.B.A., M.S.C.E., associate professor of emergency medicine and health policy, George Washington University School of Medicine and School of Public Health Services; and Marcia Wilson, M.B.A., Ph.D., lead research scientist, George Washington University.

According to the report, some positive results include:

  • Centers for Medicare and Medicaid Services have indicated it is considering using these measures for its quality reporting.
  • Field-test results have suggested the measures provide a variety of benefits and minimal burden.
  • ED/inpatient communication has reduced boarding.
  • Standardizing triage has decreased the "Left Without Being Seen" patients rate by 50%.
  • Hospitals are promoting their successes to the public.

Lessons learned included:

  • There can be meaningful process improvement without investing a large amount of resources.
  • Increasing transparency facilitates improvement.
  • Greater accountability for timeliness and quality of care was improved when top leadership and multiple departments were involved.

"I would say the one lesson that every hospital in this initiative has learned--regardless of the strategy they are pursuing--is that you need buy-in from many departments to succeed in addressing these problems," Mr. McClelland said. "They are now all getting into the trenches together."

The hospitals are now testing and refining improvement strategies, while collecting and reporting their performance measurement data. The program's successes will be shared nationwide in late 2010, giving the entire emergency medicine community not only field-tested and piloted ED performance measures, but also concrete and evaluated examples of effective change strategies that can be adopted in other hospitals across the nation.

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