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Collaborative Effort Improves ED Patient Flow

Improvement teams get little support form CEOs

The December 2015 issue of the Joint Commission Journal on Quality and Patient Safety features an article on an 18-month collaborative effort among 42 U.S. hospitals across 16 communities to improve emergency department (ED) flow from October 2010 through March 2012.

The article evaluates hospitals participating in a collaborative through the Aligning Forces for Quality (AF4Q) program. Each hospital identified one or more interventions to improve ED flow and submitted data on four related measures: 1) discharged length of stay (LOS); 2) admitted LOS; 3) boarding time; and 4) left without being seen (LWBS). 

As a result of the collaborative, a total of 172 interventions were implemented. Two-thirds of the hospitals demonstrated improvement on at least one measure of ED flow. Among these hospitals, the average reduction in discharged LOS was 26 minutes; the average reduction in admitted LOS was 36.5 minutes; and the average reduction in boarding time was 20.9 minutes. In addition, LWBS rates decreased by 1.4 percentage points.

The authors conclude that successful approaches to the improvement of ED flow require certain fundamental elements, including engaged leadership, staff buy-in, and sufficient resources. Even though most hospitals in the collaborative were able to improve on at least one measure of ED throughput, 14 hospitals did not demonstrate improvement. The authors assert that although CEO support was a requirement of initial enrollment, there was no requirement that the CEO or other corporate C-suite leadership be actively involved in the improvement teams, which may have stalled or even stopped some projects.

Source: Joint Commission Resources, November 24, 2015

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