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February 16, 2016
Is "Value" Possible in Emergency Care?
Even if your hospital is succeeding at reaping the rewards of the government’s value-based care initiatives, you might want to take a look at how the emergency department (ED) is helping you meet these goals. Although it’s easy to assume that a hospital delivering “value” overall is doing so across the board, recent research has shown that “little consistency was found in achievement or improvement across … quality domains, suggesting that the ED performance represents a distinct domain of quality.”
The implications of these findings are threefold:
- Value is possible in the ED
- The ED may be an opportunity for improvement, even in hospitals delivering value
- The ED may be the center of improvement, from which other departments in a hospital can take lessons for succeeding at delivering value.
Although the bad news is that consumers and policy-makers may not be able to understand overall facility quality at a quick glance, “there are broad opportunities for hospitals to improve,” write the authors, however, “quality improvement interventions may need to be tailored specifically to the department,” to ensure positive patient perceptions of care during emergency care. Here are some strategies for delivering value in this fast-paced and often-unpredictable department of the hospital.
1. Don’t just gather data — use them
Tailoring quality care in the ED starts with the development of patient-centered, data-driven processes to improve outcomes that matter to patients. Due to the 24/7 safety-net nature of emergency care, you need to track not only what’s going on inside the department, but the pathways by which patients are discharged to home, directed to another hospital department, or transferred to another facility. Internally, your data need to include patient-specific risk adjustments, “factors ranging from the presence of comorbidities to socioeconomic status and possibly differences in regional parameters.” Understanding who your patients are — and where they might be going — enhances your hospital’s ability to develop relationships with other facilities; to streamline pathways of care within the hospital, between departments; and understand the care and education needs of patients who are going home after treatment.
2. Attack patients’ real issue with wait times
No one likes to be left waiting, but a new white paper shows that it’s not the length of wait times in and of itself that decreases patient satisfaction. Rather, it’s that patients feel as if they’re left in the dark for long periods of time: “Patients simply want to know why they are waiting and what they are waiting for,” write the authors.
It is therefore more important to consistently provide information to patients — even in a busy ED — to manage expectations and reduce the avoidable psychological suffering caused by uncertainty, anxiety and fear. Certified medical scribes can be tasked with delivering messages and updates to patients and their families from the physician. In addition, a scribe can help the physician stay focused on the task at hand by recording notes from the tech, nurse, or another department. This lets the doctor manage new requests in order of actual priority, rather than the order in which they are delivered — and ensures the care plan for the patient in the room is executed in a timely manner. The scribe can also play a critical role in keeping the physician on track to revisit patients or follow up on test results. If the physician wants to see a patient again in 30 minutes or get a report back from radiology or the lab, the scribe can track the time and provide reminders.
However, internal processes must be focused on keeping communication flowing. Timely management of medical documents, tracking of lab work and tests in real time, and following of discharge pathways are all ways to streamline within the hospital, so that patients feel as if they are the center of care, rather than a loose end.
3. Address concerns of clinical staff
High levels of stress, sustained over time, lead to dissatisfaction, lower job engagement and, potentially, lower retention rates. This kind of extreme stress is all-too-common in EDs: 60% of emergency physicians report they are burned out, and over 20% report their workloads contribute to patient transfers, morbidity, or even mortality — all bad news for “quality care.” Worse yet, “9.2% of hospitalists reported suicidal ideation in the previous 12 months,” and when you consider 43.8% say they are emotionally exhausted and 42.3% are experiencing depersonalization, it’s no wonder so many are thinking of leaving. Twenty-nine percent say they’re likely to quit within 2 years, and 13% say they’ll definitely leave.
That’s a high rate of potential turnover — which is highly disruptive and expensive for hospitals, healthcare facilities and health systems. Replacing direct and downstream revenue is a real challenge for administrators. What’s more, when physicians leave the practice or facility, it places further strain on the remaining staff, which increases their stress, and so the circle goes on. Using medical scribes can help support physicians in engaging their patients, eliminating redundant clerical work and focusing on the practice of medicine. Freeing physiciansfrom documentation work and passing on messages for just a few hours a day can make a big difference in their abilities to do their jobs and, potentially, significantly reduce stress levels.
The ED may require separate, tailored quality initiatives to earn the highest quality improvement or achievement. What works in the surgical department may not work in such an unpredictable environment. Although the outcome measures prescribed by the Centers for Medicare and Medicaid services are important to meet for reimbursement, you won’t be able to maximize value without good data, happy patients and satisfied staff.