Innovative Strategies to

Optimize Your Emergency

Department’s Flow

Dr Sreekrishnan T P
Amrita Institute ,Kochi
• Introduction
• Before reaching ER
• After Reaching ER including triaging
• When patient in ER
• Bed transfers ,availability of IP BEDs
• Concept of CFMU
• Patient transfers and disposition
• Understand a high-level overview of ED patient
flow and operations

• Identify the common obstacles to efficient flow

and how to optimize your practice and
performance

• Recognize opportunities to optimize patient flow

for staff and patients

• Outline a plan to reduce delays and improve

patient throughput

• Identify new technologies and methodologies

that improve patient flow
• Mark all key points from the road to the ED
entrance

• Provide a welcoming destination inside the

department

• Eliminate the negative associations of waiting

rooms

• Improve way finding to treatment areas

Improve Patient Care, Safety &
Satisfaction
 Pre-care strategies
• Nurse triage and a phone line

• Psychiatry patients to have access to a health

care professional and determine whether a
visit to the ED is appropriate.

• While it is not required to be in the ED

• Proximity to the triage area is helpful because

it allows access to colleagues for more in-
depth consults.
 In-care strategies
• When a patient receives care

• Use the technology and space to coordinate with

primary care teams

• Coordinated treatment

• Sharing vital information about the patient

without incurring the costs of duplicated tests.
 Post-care strategies
• Medical care coupled with lifestyle changes

• Compliance with medication directives often

is not achieved

• Clinical pharmacist for drug briefing

• Social workers and a dedicated follow-up
referral specialist

• Centralized ED follow-up office

• Transition planners for elderly patients.

 Improving Patient Flow: Key Strategic
Concepts
• Demand/Capacity Management
• Real-Time Monitoring of Patient Flow
• Know your Constraints
• Managing Variation Managing Variation
• Teamwork and Culture
• Understand the Psychology of Waiting
patients
 ED Design / Re-design
• Door to Doctor time
• Length of stay
• ER Boarding
• Administrative support!

• Why Re-design your ED?

– Increasing volume?
– Not enough space?
– Not enough facilities?
– Poor layout?
 A Classic better ED
• Enhanced Triage

• A Fast Track system

• Bedside Registration

• Efficient Ancillary Services

• Lab and Radiology

• A Results-Waiting Area

• Efficiently Managing Admissions and Discharges

 Triage is a process, not a
place…
• Improve Throughput
• Increase Safety
• Improve Quality
• Increase Satisfaction
• Increase Revenue
• Decrease Cost
 Vertical v/s Horizontal patients
Vertical Patients Horizontal patients

• Ambulatory • Stretcher bound

• Arrived by triage • Arrive by ambulance
• Well • Sick
• Younger • Older
• Precived urgency or • Precived serious or life
conveninence threatening
 Fast track
• To segment and serve those patients that are
uncomplicated or relatively easy to treat

• Not a casual add-on or an overflow unit

• A way for relatively easy to treat patients

• Should be by an experienced doctor

Patients should be in a bed only if it is
medically necessary and only as long as
medically necessary
 Once patient reaches the bed
• Make sure that the best available team attends
the patient

• Tailor the hours and staff to the facility and to

patient flow

• Job description should be clear

• Make sure your ancilliary services are on place

Communication

Doctor

Nurse Patient
 Team Work!!!
• Doctors, Nurses & Support staff
• Healthy relationship is of paramount
importance.
• Be a team player
• Let them know your plan
 ED physcians….
• Capable of working together
• Team Leaders
• Team Followers
• The strongest
• Advocates for nurses in the ED
 CFMU
• Clinical forensic medicine unit

• This Unit which will be responsible for all

smedico legal services relating to clinical
departments

• Run by the forensic experts

• Active 24x 7
• Will be intimated to them if a MLC arrive sto ER

• Filling up the MLC case sheets,photographs if

needed,collecting all the medicolegal evidences

• Intimating the police,filling up the wound

certificates,dealing with brought dead cases…

• Anything related to MLC

• Clinicians can concentrate on patient care

 Discharge process
• Start planning as early as your first contact
with patient
• Fill out the d/s immediately.
• Do not wait for secondary/cross consultations
and evaluation.
• Pharmacy nearby for dispensing medications
• Single window billing
 Improving ED Patient process innovate in….
• Optimize and maximize patient Intake

• Optimize the Triage and Fast track

• Get the most out of your ED Bed capacity and bed

utilization

• Leverage clinical talent and time

• Maximize bed turns

• Teamwork and Culture

• Minimize the boarding burden

• Accelerate the Admissions Process

 To Summarize…
• Start from the Front end
• Triage / Fast track - Should be a process, not a
place
• Decrease the door to doctor time!
• Horizontal v/s Vertical patient
• Patient v/s Customer
• Teamwork & Communication
• Review & Critiquing