National Benchmarking Study Reveals Best Practices for Fixing the Nation's Ailing Emergency Departments

The Health Management Academy, in partnership with Picis, tap largest U.S. health networks to reveal best practice strategies to increase ED clinical and financial success 

WAKEFIELD, Mass. -The Health Management Academy (The Academy) today announced the results of the first comprehensive national study designed to measure the positive and negative impacts of various emergency department (ED) management practices on health systems. The study, independently sponsored by Picis, is a departure from earlier studies:  it not only identifies the challenges hospitals are facing in the ED, but also reveals the best practices for managing and improving ED services. Hospitals representing over half the total revenue generated in the United States participated in the survey.

In recent years, patient visits to EDs in the United States increased at a rate of 2.9 million a year, while the number of EDs has decreased from 4,019 to 3,833 during the same ten-year period. The resulting overcrowding adversely affects patient satisfaction and ED performance and causes hospitals to lose an average of $2,713 per patient when an ambulance is diverted to a less crowded facility. With increasing unemployment and fewer individuals carrying health insurance, more strain is put on EDs and the largest U.S. health systems as hospitals provide emergency care for the growing number of uninsured.

Data from the national study "Profiling Success: Managing Emergency Services in the Largest Health Systems," reveal that the top three best practices among the highest performing hospitals and health systems are:  [Figure 1]

  • Stronger strategic planning to solve the root causes of key ED issues, such as throughput, patient satisfaction and capacity;
  • A corporate executive designated to oversee ED management and performance system-wide, considering it a core business area; and
  • Greater utilization of information technology (IT) solutions.

Hospitals and health systems utilizing these approaches demonstrated a positive impact on the clinical and financial performance of the entire healthcare organization that could be replicated across health systems.

The study surveyed large health systems' strategies for addressing ED challenges and revealed best practices for managing and improving ED services. It was conducted through in-depth surveys of more than 70 percent of The Academy's membership, which consists of 90 hospitals and health systems in the United States, accounting for more than 50 percent of the net patient revenue nationwide. Study participants include industry leaders such as NewYork-Presbyterian Hospital, Moses Cone Health System, Vanderbilt University Medical Center, Partners Healthcare, Banner HealthCare, John Hopkins Hospital and Montefiore Medical Center.

"For many patients, the emergency department is their point of entry to the hospital and where the documentation of vital information begins," said Drew Swiss, vice president of finance, Montefiore Medical Center in Bronx, N.Y. "Complete and accurate records are essential in supporting the quality and safety of inpatient care as well as outpatient follow-up and billing.  Hospital leaders, their organizations and their patients will benefit from the adoption of the best-practices and innovations recommended by the study."

A New ED Blueprint: opportunities for strategic planning

Constrained capacity was the dominant force [Figure 2] affecting hospitals' strategies, and most organizations remained focused on process improvement, staffing and expansion initiatives. Of those implementing ED-focused strategies, 83 percent were focused on enhancing quality, 71 percent on coordinating care and 67 percent on expanding existing ED facilities [Figure 3]. However, while ED renovation and construction are commonly aimed at easing capacity issues, without strategies to fix root problems, capacity management remains an issue and continuous expansion is not sustainable.

Although nearly 90 percent of study participants [Figure 4] reported that ED services play a crucial role in their health system's overall strategy, the management infrastructure to execute that strategy across ED services is still in development at many institutions. [Figure 5] The opportunity exists for hospitals to enhance quality and better coordinate care by implementing specific strategies and technologies for tying clinical and financial efficiency together.

"The study found that even the most forward-thinking health systems with a range of resources are challenged to develop a successful ED strategy," said Jeffery L. Wajda, D.O., M.S., F.A.C.E.P., vice president of clinical support services at LYNX Medical Systems, a Picis company. "The importance of corporate-level oversight and strategic planning in the ED is becoming increasingly critical for hospital and health systems as a whole, since at least 50 percent of hospital admissions enter through the ED."

At the Helm: opportunities for leadership

The survey revealed that responsibility for ED performance can be assigned to one of eight different roles within a hospital or health system [Figure 6], from ED director to chief nursing officer to the CEO. In addition, nearly 70 percent of participants do not currently rely on a system-level executive to coordinate care in or across the EDs. Health systems with a single corporate executive in place at the system level with responsibility for system-wide ED performance demonstrated better outcomes, including higher success with process improvement solutions, stronger core measure performance and higher bond ratings.

"Because of the unique demands of the ED, responsibility for ED services is often diffused across many executives," said Gary Bisbee, Ph.D., chairman and CEO of The Health Management Academy. "Health systems that maintained a full time corporate-level ED ‘point person' were better able to implement best practices, experienced greater success in process improvement solutions, and were more likely to leverage information technology solutions in the ED."

IT to the Rescue: opportunities for technology

The study also revealed that the single largest opportunity for making significant gains in solving the challenges of the ED lies in the expanded use of IT, where 55 percent of health systems deployed evidence-based best practices compared to rates between 76 percent to 88 percent for staffing, process improvement and system change solutions.[Figure 7] With environmental factors such as Recovery Audit Contractor (RAC) audits, stimulus legislation incenting IT adoption and the increasingly challenging economic climate, hospitals need technologies that have been proven effective and that provide visibility into the downstream effects of the ED [Figure 8]

 "In today's challenging economy, every hospital and health system in the country should be focused on re-evaluating the use of IT to make improvements in the ED," said Todd Cozzens, CEO and vice-chairman, Picis. "New regulations will soon require EDs to capture the details and complexity of a patient's condition and diagnosis at time of admission - without it, the hospital will not be reimbursed for that care. This study shows that planning, leadership and technology tailored for the needs of the ED are critical in helping hospitals prepare for these regulations and maintain profitability."

To download the study, "Profiling Success: Managing Emergency Services in the Largest Health Systems," and to register for a live, interactive webinar scheduled to be held on May 12 at 2:00 p.m. ET, visit This webinar will feature:

  • Nancy Auer, M.D., F.A.C.E.P., former chief medical officer, Swedish Medical Center;
  • Paul A. Clark, M.P.A, F.A.C.H.E., senior director, research and programming, The Health Management Academy;
  • Jeffery L. Wajda, D.O., M.S., F.A.C.E.P., vice president of clinical support services, LYNX Medical Systems, a Picis company.

About The Health Management Academy   
The Academy provides an open environment for the senior executives of the country's largest health systems and corporations to exchange best practices and benchmarking information, focused on increasing the quality and efficiency of care. The Academy is a knowledge source for identifying and monitoring tactical and emerging strategic issues. The Academy was formed in 1998, the same decade many of the largest health systems were created. The Academy's model of educational programming assesses the top priorities of its members, monitors the organization and development of large health system executive teams and facilitates structured interaction among its health system members. The Academy is an accredited CE provider. More information is available at

 About Picis    

Picis is a global provider of innovative information solutions that enable rapid and sustained delivery of clinical, financial and operational results in the acute care areas of the hospital. These high-acuity areas include the emergency department, operating and recovery rooms, and intensive care units. Picis offers the most advanced suite of integrated products focused on these life-critical areas of the hospital where the patients are the most vulnerable, the care process is the most complex and an increasing majority of hospital costs and potential revenue are concentrated. Headquartered in Wakefield, Massachusetts, Picis has licensed systems for use in more than 1,700 hospitals in 19 countries. More information is available at