CDC study shows EDs opportunities to improve
CDC study shows EDs opportunities to improve
Survey said to have greatest value for ED managers
ED managers are deluged with statistical reports from many government agencies, and yes, your eyes can glaze over glancing over page after page of seemingly endless numbers. However, an astute ED manager can yield untold benefits from such studies in terms of improving your department’s performance, better understanding your own numbers, and in demonstrating to the community (and administration) just how well you are doing.
One annual study ED managers have found extremely valuable is the Center for Disease Control and Prevention’s statistical survey of ED operations: the National Hospital Ambulatory Medical Care Survey (NHAMCS). This year’s 36-page study, which reports statistics from 2003, can be downloaded free of charge from the NHAMCS web site.
Shari Welch, MD, the ED director at LDS Hospital in Salt Lake City, finds value in the study "because I am a data junkie," she admits. EDs usually get it right when it comes to providing health care, Welch adds. "It’s on the operations side" that reports such as the NHAMCS have the greatest value, she says.
The numbers are probably not true benchmarks as far as operations is concerned, but they do give some guidance for how certain EDs of certain sizes should be managed, says James J. Augustine, MD, FACEP, MD, FACEP, director of clinical operations at Emergency Medicine Physicians (EMP), a physicians group based in Canton, OH. "What’s most relevant are the types of patients being seen, what we need to do to serve them, the nature of illnesses versus injury, and certain future trends we need to prepare for," he says.
Getting to specifics
Each year, Augustine prepares a summary for his colleagues and notes some of the key points raised by the NHAMC study. This year, transfers were among of the major issues he cited.
It’s important for an ED manager to know his or her transfer percentages, Augustine says. It’s a very important operations monitor, he adds. "It indicates what services the hospital is and is not able to provide," he says. "If the ED is seeing more transfers, it may indicate medical staff is leaking out of the hospital, because if you transfer people, it means you do not have a specific service available."
For example, if you lose staff with expertise in pediatrics, you may watch your pediatric transfers begin to increase, he says. "If you get to the point where you have a lot of pediatric transfers, the ED manager needs to decide how to respond," he says. "Do you increase your scope of pediatric services, or on the flip side, do you set up better relationships with children’s hospitals?" Some very astute hospitals have shut down pediatric services and begun to tell their emergency medical services to take sick or injured children to a pediatrics-capable facility, Augustine says. They tell parents, "We are wonderful ED, but your children are better served elsewhere."
Diagnostics: A growing area
The NHAMCS also gives ED managers a look at developing trends. "The use of EKGs, imaging, and respiratory services [in the ED] is a relatively new trend to follow," notes Augustine. "[The study] gives the ED a much clearer picture of what services it must provide."
Welch agrees. "As patients age, they use more resources in the ED," she notes. "We can predict that older patients will need more diagnostics."
This need, in turn, impacts statistics such as length of stay. Last winter, managers were discussing the results of tracking people with stays of greater than six hours. Welch always had heard the benchmark was 4% or under. "What I shoved up against was more tests," she says. "CAT scans of the abdomen are, at a minimum, a four-hour process, so you already know you are well on the way to a six-hour stay." MRIs from her ED have gone up 400%-500% since 2000, Welch says.
Another time-consuming modality is cardiac stress testing, she says, "But it lets you send home a chest pain patient you would have had to admit 10 years ago," Welch says. These longer, more complex work-ups may have an upside, however. "I still only admit 27% of people who stay for six hours, which means most still get to go home and go safely," says Welch. "Maybe it’s not so bad, if we can better clarify who is truly ill." The trend also has given rise to some creative responses, such as a holding area. "This is an observation area, where you can put someone who needs 12-24 hours of observation," Welch explains.
Understanding what the numbers mean also can help you present a better image for your ED, says Augustine. For example, injury rates have fallen, he says. Point to the success of injury prevention programs, Augustine suggests. ED managers should let the community know that programs such as trauma prevention and cardiac health are working, he says. "Reducing head injuries by 75% is a remarkable figure," Augustine says. "We don’t celebrate our successes enough."
The final number you should know very well is the percent of overall hospital admissions presenting through the ED, says Augustine. This is a great trend to follow, he says. "Almost all the EDs I am familiar with have more than 50% of hospital admissions coming through the ED, and the average number is 63%," Augustine says. This number can be shared with administration as a way of obtaining increased staffing and other resources for the ED, he suggests. "This clearly demonstrates that the ED is the front door to the hospital.’"
Sources/Resource
For more information on using statistical studies to improve ED performance, contact:
- James J. Augustine, MD, FACEP, Director, Clinical Operations, Emergency Medicine Physicians, 4535 Dressler Road, Canton, OH 44718. Phone: (330) 493-4443. E-mail: [email protected].
- Shari Welch, MD, ED Director, LDS Hospital, Salt Lake City. Phone: (801) 947 5782.
To download a free copy of the National Hospital Ambulatory Medical Care Survey report, go to: www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm. Then, scroll down to "Data Highlights — Selected Tables, Charts, and Graphics" and click on "Emergency Department Visit Data."
ED managers are deluged with statistical reports from many government agencies, and yes, your eyes can glaze over glancing over page after page of seemingly endless numbers.Subscribe Now for Access
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