Improving Patient Flow in Emergency Departments


ImprovingPatient Flow in Emergency Departments

ImprovingPatient Flow in Emergency Departments


Thefollowing interview was conducted at the emergency premises of theJohn Hopkins Medical Center. The interviewee is the Chief ofEmergency Services while the interviewer is a student of WaldenUniversity MHA program. The interview questions and responses of theChief emergency are as follows:

  1. What are crucial challenges this ED has faced in recent years related to patient flow?

Thebiggest challenge is overcrowding of patients that need emergencycare. All processes flow smoothly except the diagnostic evaluationand ED treatment stage where it takes quite longer to carry theprocesses. The second challenge of is housekeeping. A majority of EDadmissions take place in the evenings when most of the housekeepingnurses are away.

  1. On what basis were these challenges identified? Were quantitative data used to identify and confirm the existence of problems, and if so, which types of data?

Theproblem is identified through physical data collections of the timeED patients take at every stage of ED care. The results indicated ahuge number of patients in every thirty minutes in the diagnosticevaluation and ED treatment stage. It was actually thrice the numberof other departments that had a small deviation.

  1. Focusing on one of these challenges, what process improvement or reengineering efforts has this ED taken to address the challenge?Did the department follow Lean and/or Six Sigma or other comparable approaches in addressing this?

Overcrowdingis being reduced trough using advanced technologies to ensure asmooth coordination of nurses, doctors, and all specialists inancillary services. The ED adopted the six sigma approach,specifically the DMADV process that was used to introduce thetechnologies.

  1. Did the ED use any internal or external best practices to make these changes? If so, which ones?

Both,for purposes of high quality ED care. Internally, the best practiceused is to meet is ensuring that the new technologies have anefficient maintenance plan. The external best practices were based onthe recommendations of the National Center for BiotechnologyInformation (NCBI).

  1. Did the organization or ED establish any metrics to determine if expected outcomes are being met? If so, what were the metrics?

Yes,the metric used is the patient headcount for every thirty minutes.First, the time it takes for the ED patient to move to the next stagewas compared, and then the number must the same in the diagnosticevaluation and ED treatment stage as in previous and precedingstages.

  1. Did the implemented changes achieve expected outcomes?

Yes,on a very significant scale. The average number of ED patientswaiting at each stage for every thirty minutes dropped from 33 to 8.

IndustryBest practices for reducing overcrowding in ED

Theindustry best practices for reducing overcrowding are introducingadvanced medical and communication technologies. The medicaltechnologies hasten the process of diagnosis and evaluation of the EDpatient. The communication technologies improve the coordination ofnurses and specialists at each stage of ED. There are three mainphases as recommended by the NCBI on new technologies in hospitals.They include:

  1. The assessment phase: The assessment stage entails clinical assessment of new technologies in which the results determine whether or not the technology should be adopted(Li, Lau, McCarthy, Schull, Vermeulen&ampKelen, 2007). Assessment ensures that the need to expedite ED care does not override the pertinent need for patient safety. Assessment also helps to prevent administering unnecessary medical procedures due to the misdiagnosis that may take a longer time than it is necessary. The assessment process of tests the effectiveness and efficacy of new medical technologies. The medical delivery environments are vital determinants of this quality assurance aspect because they differ significantly in different health care settings.

  2. The deployment phase:Deployment entails introducing a new technology into the medical settings and adopting it in medical routine. Technologies differ in their usability and integration into clinical practice(Moskop, Sklar, Geiderman, Schears&amp Bookman, 2009). For instance, the communication devices used in this case must be fit to be used in clinical settings especially in ED. Hence, deployment strictly considers the efficacy of the technology and the way it works for ED.

  3. The monitoring phase: As the Chief emergency officer mentioned in the interview, the metrics of measuring the impact of solution to ED are the number of patients each stage of ED in every thirty minutes. Thus, a reduction indicates a positive outcome of technology. However, the hospital needs to identify loopholes of improvement.

Stakeholderslikely to be affected

Thestakeholders to be affected by this change are: specialistsespecially in the diagnostic evaluation and ED treatment stage, themanagement, and nurses(Institute ofMedicine Committee on the Future of Emergency Care in the US HealthSystem, 2007).The introduction of advanced communication and medicaltechnologies is likely to impact positively on the delivery ofpatients while requiring the management to use project managementskills.


Allefforts toward managing patient flow in the ED fundamentally shapesquality and safety of care. Solutions such as the one adopted by theJohn Hopkins hospital critically eliminate inherent bottlenecks topatient flow in the ED. Technology also does way with the artificialvariabilities that cause crowding. However, cost effective projectmanagement practices are likely to minimize waste and the costs ofexecuting such solutions.


Instituteof Medicine Committee on the Future of Emergency Care in the USHealth System. (2006). Hospital-based emergency care: at the breakingpoint.

Li,G., Lau, J. T., McCarthy, M. L., Schull, M. J., Vermeulen, M.,&ampKelen, G. D. (2007).Emergency department utilization in theUnited States and Ontario, Canada. Academic Emergency Medicine,14(6), 582-584.

Moskop,J. C., Sklar, D. P., Geiderman, J. M., Schears, R. M., &amp Bookman,K. J. (2009). Emergency department crowding, part 1—concept,causes, and moral consequences.Annals of emergency medicine, 53(5),605-611.