Colorado hospital reinvents its ER, slashes wait times and costs

A bigger emergency department won't be better unless delivery of care transforms along with the facility expansion, according to the the head of the University of Colorado Hospital emergency department.

"Instead of being small, crowded and dysfunctional, many EDs are now big, crowded and dysfunctional," Richard Zane, M.D., wrote in the Harvard Business Review. "That's not progress."

The university hospital avoided a similar fate by creating groups of eight to 10 providers to quickly examine three core functions: quality, operations and process improvement. A nurse and a doctor led two of the three groups, with an engineer joining a nurse and doctor to lead the process-improvement group. Members rotated among the subcommittees, which had no more than two weeks to develop concrete plans to execute ideas, he said.

The hospital used the following guided principles during the process:

• Every change must benefit patients. As a result, the team improved the patient experience by eliminating triage and having a senior physician see each patient within minutes of arrival.
• Value everyone's perspective while speaking with one voice. The two principles combined led to the hospital moving the ED observation unit when it became clear the location didn't work, and delivering portable X-ray machines to certain non-critical patients rather than moving the patients to the machine.
• Develop specific care pathways to guide care for high-risk presentations including heart attack, stroke and sepsis, or those associated with significant practice variability, such as chest, abdominal and back pain. As a result, the ER cut the use of high-cost imagery by 15 percent and avoidable hospital admissions by 20 percent.

The larger, redesigned ED increased volume by 53 percent, cut total treatment time by more than 40 percent and virtually eliminated the number of patients leaving without being seen. It also cut the time from patient arrival to being seen by an attending physician to less than eight minutes, according to the article.

In the past the ER had to divert ambulances for an average of eight hours every day. However, thanks to the redesign, Zane wrote that the department never has to divert ambulances.

The University of Colorado Hospital appears to be ahead of the curve: A recent study found that the most crowded emergency departments haven't bothered to adopt proven interventions that could reduce overcrowding. One reason appears to be that many hospitals don't consider ED overcrowding a top priority, FierceHealthcare previously reported.

Elsewhere, though, 42 hospitals in 16 U.S. communities worked together to improve ED patient flow. By sharing the results of various strategies and interventions, two-thirds of the hospitals achieved measurable improvements, including reducing the length of stay for both discharged and admitted patients.