Hospital Efficiency: Do All ER Patients Need Beds?

August 25, 2011

By Kat Darula, Director of Design Research

A recent article in The Wall Street Journal sparked spirited debate on care for emergency department (ED) patients. Reporter Laura Landro’s story, titled “ERs Move to Speed Care; Not Everyone Needs a Bed,” sheds light on a major challenge facing hospitals nationwide: improving hospital care and efficiency takes much more than cost cutting efforts. The article covers lean principles and other efficiency models that hospitals are implementing to recover revenue and enhance the patient experience, including streamlining traditional triage methods, reserving beds for the sickest patients, publishing hospital wait times online, and testing other innovative solutions to provide timely patient care.

In a pilot recently completed by our Healthcare Delivery Solutions team as part of a larger hospital quality improvement project, emergency room wait times (for patients to see doctors) decreased from an average of 1 hour, 42 minutes to an average of 22 minutes. In addition, the percentage of patients who left without being seen decreased from 7% to 0.8%, well below the national average. We also were able to test our model and successfully improve bed utilization without adding physical space or staff.

So I believe transforming the way EDs deliver care can reduce wait times while simultaneously enhancing quality of care, safety, and satisfaction. I’ve seen it happen in our own work, and it’s very encouraging.

But truly optimizing ED performance to increase quality — not compromise it — requires a thoughtful and holistic approach. This approach must be developed with consideration to all people and processes impacted beyond the ED, including inpatient and ancillary areas of the hospital. Hospitals that address these national challenges with collaborative, transformative action will be successful in navigating the tough economy of today’s healthcare environment and the ever-rising expectations of patients.