Saturday, February 25, 2023

Boarding Patients in Your Emergency Department?

Is your hospital no longer the best place for your sickest patients?
You are not alone.

Check out the recent article from the American Academy of Emergency Physicians here

How did this happen?

1. It happens due to staffing holes exacerbated by poor working conditions;

2. Efforts to manage patients' lives by benchmarks and ratios.

3. Weak staffing pool development needed to cover all shifts with high experienced crew engaged in longer, meaningful career ladders.

4. Misguided efforts to thin support staff, supervisors / Charge RNs and front-line management to curb costs.

5. Focusing disproportionately on low acuity / high margin patients.

6. EHR workflows, bed management tools and task lists sold to help workflow but which segment, section, silo and stack patients. Now people work to their work lists, not with each other.

7. The decision to use median throughput time values in the Emergency Department, erasing boarder patients from the Emergency Length of Stay calculations, erasing accountability: It was never "just" an Emergency department problem. But now it's also not an Inpatient one's problem but the patient.

8. These are all the result of weak Emergency / Inpatient / Support / Clinical Diagnostic consulting by an army of "Subject Matter Experts" blinkered to cut costs within the siloes of each department.

9. Poor or non-existent work engineering.

These have only worsened the Emergency Boarding Patient problem. And an unsolved problem leads to blaming the victims, your patients.

When this happens staff, management and executives begin to burn out, leading to anger and denial, which never solved anything. Then blame and burnout become your culture, with all the power of the status quo behind it. At that stage no solution is supported.

The biggest secret of all? Blame isn't the answer, understanding is. No blame is needed. Ever. It's a Systems Thang: Emergency departments are downstream of the hospital, functionally, not upstream. Patient flow doesn't begin with a new patient at the Emergency Department door or the call from the ambulance team. It begins at the moment the inpatient nurse confirms their patient is likely to be ready for transfer or discharge.

It is not an Emergency Department problem. It's a Hospital and Health System problem.

Stop the old thinking that makes things worse.
Find real solutions here..

And the best consulting support in the nation to help you get there:
And if you need more inspiration that boarding was fixed decades ago in our best Emergency Departments before, during and after a national pandemic, read more than a dozen Emergency and House-wide Patient Flow and Patient Satisfaction case studies here

Become the number one hospital again.

#hospitalmanagement #populationhealthmanagement #emergencymedicine #nurseleaders

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