EMTALA
Overview The Emergency Medical Treatment & Labor Act (EMTALA) was enacted by Congress in 1986. The intent is to ensure public access to emergency services. EMTALA requires that if a patient presents for care at a Medicare-participating hospital with an emergency department, the hospital must provide a medical screening examination (MSE) and provide stabilizing treatment […]
Emergency Severity Index
The ESI is a tool used in the triage of patients presenting to the ED. A 5 level scale, patients are assessed and then grouped not only by acuity, but also resource need. The 5 levels include1: In the traditional model, patients at a level 4 or 5 are generally subjected to longer wait times […]
Vertical Flow
Emergency departments are exploring various forms of throughput improvement, including changes to processes, staffing, technology and space utilization. The vertical flow model consists of changes to intake and bed assignment processes, as well as use of vertical treatment rooms. These rooms are smaller than a traditional emergency department room and feature a chair or assessment […]
Split Flow Model
Emergency department crowding can be addressed as a problem of input, throughput and output, and understood from the perspective of the patient and health system. One option that many high volume and academic medical centers have explored is a ‘split-flow’ approach, which disrupts the traditional approach where every patient follows the same path through ED […]
Strategies Addressing ED Discharge
Current research points to the fact that discharge from the ED is likely the biggest congestion point, and biggest factor contributing to ED overcrowding. Just like on the ED input side, there are many components of this problem that are outside the scope of what the ED can control; however, ED teams can work with […]
Efficiency Targets in ED Throughput
An ED patient visit often requires many steps, and within and between each step there is potential for improved efficiencies. Diagnostic Testing Diagnostic testing and specialty consultations can often create bottlenecks in ED flow. Turnaround time for labs, imaging, and specialty consults include time involved in ordering testing, any needed patient transportation, time for performance […]
Strategies in Response to ED Input
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 […]
Why Don’t We Just Make the ED Bigger?
More space for the ED would definitely be helpful, but is likely not the entire answer. Much like traffic congestion which doesn’t improve when extra lanes are added to highways,1 ED overcrowding is unlikely to be solved by just increasing space. In fact, a study conducted at an academic medical center that expanded its ED […]
Traditional Model
The traditional model of providing care is largely based on a first-come, first-served basis that is modified by acuity. Using the Emergency Severity Index, patients are first triaged and grouped by their severity level, with critical patients being treated immediately, and less emergent cases being treated largely in the order in which they presented to […]
Why do people come to the ED?
The reasons people walk into the ED vary, but generally include1: It is also well documented that people who often present to the ED could have been treated in another setting, or have prevented the ED trip all together with better preventative care2. For many, lack of medical insurance and inability to pay prevents access […]
