Door-to-doc model improves ED flow, cuts costs

Hospital leaders looking to improve care delivery while lowering costs should focus their operations management efforts on the emergency department (ED) and should consider embracing the door-to-doc model (D2D) to match patient demand to services, beds and providers, according to a column published yesterday in Hospitals & Health Networks Daily.

For every 1 percent of patients who leave before a care provider sees them, EDs with volumes of 50,000 patients lose revenue worth approximately $500,000, according to the article.

The D2D model acknowledges that patient demand and variability are predictable. The model, therefore, bases staffing of more ED workers during the busy hours and fewer staff members during the slow times of the day.

Hospitals also can reduce unnecessary ED visits and wait times with the D2D model, H&HN Daily notes. After patients arrive at an intake room (which may not be a physical room), an ED worker immediately evaluates them and orders tests and treatments. The model then discharges patients who don't need admission to a continuing care waiting area, saving beds for those with emergent issues.

The D2D model also categorizes ED visitors into complex, high-acuity patients and lower-acuity, less complex patients. Because 80 percent of lower-acuity patients don't require a highly-skilled ED physician, a non-physician provider can perform the tasks (such as collect data, verify allergies and write discharge instructions) at a much lower cost, according to the article.

Meanwhile, researchers found that ED patients don't stick to one hospital ED for care, indicating that ED patient loyalty wavers, according to a new study from Indiana University School of Medicine. In fact, 40 percent of ED visits in Indiana were by patients who had visited more than one ED in three years. "Nearly all emergency departments in Indiana shared patients with nearly every other emergency department," according to a press release earlier this week.

Recognizing high overlap and other ED trends could help hospitals as they develop operations management strategies to streamline emergency care.

To learn more:
- read the H&HN Daily article
- check out the Indiana University press release