There are a number of ways to think about reducing the flow of patients coming to the ED, and many are important considerations for providing the optimal healthcare to our communities, but these are outside the scope of our current project. We’ll begin by considering strategies that can be considered once patients have arrived at the ED.

Work Schedules

We have data on patient volumes that can be arranged to help understand the flow of patient arrivals to the ED over days of the week and hours of the day. Even with the understanding that patient volumes in the ED are somewhat unpredictable, we can use these data to help guide schedules for our clinic team members. By aligning our clinical team schedules and shifts with historic patient demand, we’re more likely to be able to meet the needs of patients.¹ This strategy is somewhat constrained by clinical space, and other resources needed to care for people that might not be scalable in the same way. There is also the possibility that busy ED times might not coincide with popular work-shifts.

Telemedicine-Triage

Patient triage is a critically important branchpoint in ED patient flow. A review of the use of telemedicine in the ED found that physician triage may have a role in triage of non-critical cases. Telemedicine has the advantage of flexibility and potentially lower costs, since physicians may staff it remotely and can be activated at times of need. The differential quality of in-person versus virtual triage has not been fully evaluated, but small randomized studies have shown high diagnostic concordance with in-person assessments for non-critical patients.² Telemedicine may have a role in helping to manage some of the ED intake steps, and help reduce the workload on clinicians providing in-person care.

Patient Assignment

In most EDs, providers self-assign patients to themselves – decisions may be based on perceived capacity to treat another patient, how busy the ED is, how much time is left in their shift, and a variety of other factors. But research has shown that a system of rotational
patient assignment, where an algorithm loaded with predetermined criteria is used to assign patients to physicians or teams, may lead to improvements in LOS and reduced rates of LWBS.³ A substantial benefit of this system is that patients are assigned to providers essentially immediately, so that there is clear accountability and responsibility that can help streamline early care decisions. On the other hand, this type of assignment, especially in the early transition period can feel like a substantial loss of autonomy to the providers, which can affect burnout and work satisfaction.

References

1. Joseph JW, White BA. Emergency Department Operations: An Overview. Emerg Med Clin North Am. 2020 Aug;38(3):549-562.
2. Ahmed AA, Mojiri ME, Daghriri AA, Hakami OA, Alruwaili RF, Khan RA, Madkhali HA, Almania MM, Hakami ZT, Mashraqi KO, Adawi KA, Alqattan SA, Alharbi AN, Albahlol MA, Moafa AI. The Role of Telemedicine in Emergency Department Triage and Patient Care: A Systematic Review. Cureus. 2024 Dec 10;16(12):e75505.
3. Traub SJ, Stewart CF, Didehban R, Bartley AC, Saghafian S, Smith VD, Silvers SM, LeCheminant R, Lipinski CA. Emergency Department Rotational Patient Assignment. Ann Emerg Med. 2016 Feb;67(2):206-15.