The Ten Basics of Improving an Emergency Department

  1. Whenever possible, immediately place patients in the ED after triage, rather that the waiting room when beds are available.
  2. Have workable standing orders for selected patients that can be initiated by the triage nurse.  This can reduce time spent in the ED and improve compliance with so-called quality measures.
  3. Register the patient at the bedside.  This removes registration from the time of the ED visit.
  4. Organize work areas to maximize the efficiency of the providers (MDs,PAs,NPs).  Assign "zones" of responsibility and make a target time for seeing patients, i.e. within 10-12 minutes after being placed in the treatment room.
  5. Use a workable patient tracking system. This can be a whiteboad or a computer system, but it must be efficient and intuitive to use.
  6. Have a system for tracking charts.  Don't waste time looking for a chart, know where the chart should be during every phase of care.
  7. Dictate the chart. It's fast, efficient, can capture all the data for accurate coding and is far superior if you have to go to court.  Best of all, with new software programs, it's also become a lot cheaper.
  8. Make a disposition.  Don't let patient's sit for hours after their work-up is complete. 
  9. Don't let the hospital keep admits in the ED.  They get less than optimal care and suffer higher mortality and morbidity.  This is a hospital problem and to not address it is negligence on the part of the hospital.
  10. Don't let admitting physicians hold up the ER.  Develop a hospital protocol that requires an admitting physician to either a) see the pateint within 30 minutes or b) use brief admitting orders to get the patient to an appropriate inpatient bed as soon as possible.