Children's Hospitals Today - Summer 2023 - 28

FEATURE / EMERGENCY CARE
THROUGHPUT
This is the way patients move through
the system once they are in the ED.
Delays can occur in this stage based
on ED space and staffing limitations
or misalignment; seasonal variations
resulting in sudden surges of patients;
or complex patient cases that require
extensive evaluation and consultation
from multiple disciplines and
specialists. Other factors include language
and cultural barriers, electronic
medical documentation, and medical
liability issues.
At Children's Hospital of Georgia,
space is a significant driver of ED
crowding. Lane and her team see about
30,000 patient visits a year. To meet
that demand statistically, Lane says
the ED should have 20 beds; yet, it only
has 16. Add to that the fact that more
than a quarter of the beds in Lane's ED
are often occupied with mental or behavioral
health patients, further limiting
the capacity for other children
coming in for emergency care.
According to Timm, throughput
depends heavily on operational
processes such as staffing, room
turnover and flow between the ED
and departments like radiology, labs,
respiratory
care,
and
pharmacy.
Delaying any one of these things, he
says, cascades down to the ED, causing
backups that lead to crowding.
For example, a slowdown or shortage
in environmental services can mean
rooms on the floor are not turned fast
enough for patients to transition out
of the ED and into a bed. It could be
that a radiology study takes a long
time or the lab is busy, so bloodwork
is slow to come back, Gross says. " It
may not seem like all these things
are related, but the entire operations
of the hospital trickle down into
the emergency department, " Gross
says.
" We need to look at all of the
drivers that go into what's happening
and ask ourselves, 'Where can
we trim 5 minutes off here and 10
minutes off there?' "
Of all the challenges to throughput,
staffing tops the list for pediatric
EDs. Lane's 10-person department
doesn't always have enough ED
physicians to cover every day of the
month, and there are limited options
for on-call doctors. Then, there is the
ever-present need to be prepared for
a sudden surge or disaster. " It's one of
the most difficult things that hospital
planners and health care system
planners have to balance, " says Gross.
" You don't want to be so efficient
with your operations and resources
that you don't have capacity for a
disaster or mass casualty incident or
seasonal surge in patient activity. "
SOLUTIONS
How patients move
through the system
USE fast-track assessment
zones to match patient needs
with resources more quickly.
PUT a provider in triage for
faster assessments.
ADMIT patients to preoperative
or post-operative
care spaces.
LEVERAGE scribes for
increased provider efficiency.
USE a direct-admit referral
process to admit patients
without an ED stop.
UTILIZE staff from different
departments or roles creatively
to fill non-clinical care needs.
OFFER bedside registration or
kiosks to speed the process.
USE capacity management
systems to track patient flow
resource availability throughout
the system.
HOLD daily multi-departmental
huddles to discuss throughput
barriers and solutions.
TREAT patients in alternative
spaces rather than taking up a
bed when possible.
Surge strategies
Learn how two hospitals
dealt with the surge of
respiratory viruses. Visit
childrenshospitals.org/
respiratory.
28
CHILDREN'S HOSPITALS TODAY Summer 2023
http://www.childrenshospitals.org/respiratory http://www.childrenshospitals.org/respiratory
Children's Hospitals Today - Summer 2023

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