Emergency Room Efficiency: Time for a Major Redesign?

By Emilio S. Belaval, MD, FAAEM

According to a March 2011 survey [PDF, 236KB] conducted by the American College of Emergency Physicians, many doctors believe emergency rooms will become busier places, despite healthcare reform.

In the survey — an email questionnaire sent to 20,687 U.S. ER physicians to which 1,768 replied — more than 80 percent of emergency room physicians say the number of patients seen in ERs has either increased somewhat or significantly over the last year, a trend they expect to continue.

The physicians surveyed attribute the projected increased usage to multiple factors:
While some of these data contradict the intent of healthcare reform — to increase the number of patients with health coverage and thereby decrease ER usage — there is some good news: The vast majority of ER doctors surveyed believe that ER costs can be reduced without sacrificing patient safety.

• A rise in patients without health insurance (27.60%)
• An aging population (22.60%)
• Physician shortages (15.60%)
• A growing national population (12.60%)
• An increase in new Medicaid patients (8.80%)
• An increase in patients with health coverage (4.580%)

I couldn’t agree more.

By applying queuing theory, lean production methods and other operations science concepts to redesign hospital patient flow processing, emergency room crowding can be significantly eased without capacity expansions or staff increases. Besides financial savings, improving operations also helps eliminate sentinel events and improve overall patient safety.