1st Edition

Optimizing Emergency Department Throughput Operations Management Solutions for Health Care Decision Makers

By John M. Shiver, David Eitel Copyright 2010
    260 Pages 73 B/W Illustrations
    by Productivity Press

    260 Pages
    by Productivity Press

    Across the country ambulances are turned away from emergency departments (EDs) and patients are waiting hours and sometimes days to be admitted to a hospital room. Hospitals are finding it hard to get specialist physicians to come to treat emergency patients. Our EDs demand a new way of thinking. They are not at a tipping point; they are at a breaking point. Under current loads and trends they are going to begin to break and these breakdowns will be painful and ultimately dangerous to society.

    Recognizing that the ideal in health care is presently beyond our immediate grasp, this book instead focuses on providing health care leaders with the tools they can employ to optimize the performance of EDs and thereby improve service to patients, employees, and communities.

    Written by 20 of the most progressive and successful health care reformers in the country, the approaches described can be utilized to quantify improvements, enhance predictability of workflow, and improve staff scheduling. The data derived using these techniques can serve as powerful evidence in support of change. While a common discussion among ED professionals is the perception that many patients are not really emergency patients and could be treated in another setting at another time, that argument is not germane until we as a nation elect to reform the way we chose to deliver healthcare to the underserviced.

    In the meantime this book provides invalauable information to help individual hospitals to retool their ED’s. It offers new approaches that think outside of the box for all stakeholders. It also provides the statistical evidence that administrators need to make their cases for changes and added resources. It will help you forecast the demand for services and give your center an approach that will allow the ED to become a source of income rather than one that continues to hemorrhage needed limited health care funding.

    Introduction: Description of Current Status of Emergency Departments and Hospitals

    Fixing the Front End: Why Would an Emergency Department Medical Director or Nursing Supervisor Wish to Install Emergency Severity Index (ESI) Triage? D. Eitel and T. Falvo

    Process Mapping and Workflow Diagramming in Health Care, S. McKniff

    What is Lean Six Sigma? An Introduction to Lean and Six Sigma for the Health Care Novice, D. Eitel

    Using Lean-Six Sigma to Accelerate Emergency Department Results, G. Butler , C. Caldwell, and S. Elswick

    Queuing Models for Hospital Emergency Departments, Y.A. Ozcan

    The Nursing Perspective and Role in Planning a Simulation Modeling Project: Historical, Experiential, and Future Applications of Complex Adaptive Systems Thinking; with an Emergency Department Case Study, S. O’Hara

    The Physiology of Service Capacity, P. Story and D. Eitel

    The Door-to-Doc Toolkit: Planning Emergency Department Capacity for Delivering Safe Care, T.L. Burdick , J.K. Cochran , R. Andrews , M.E. Bucco, J.R. Broyles , and K.T. Roche

    Forecasting the Demand for Emergency Department Services, M.J. Côté, E. Akçalı, and D. Eitel

    Improving Fairness in Nurse Scheduling: Introducing a New Approach Using Auctions and Integer Programming Optimization, M.L. DeGrano

    Establishing Engineered Nurse Staffing Requirements in the Emergency Department, F. Overfelt

    Patient Safety Organizations: A New Paradigm in Quality Management and Communication Systems in Health Care, D.B. Dotan

    Alternative Emergency Care Settings, J. Lifton

    Appendix A : Case Study—Surviving and Thriving in Emergency Department Chaos

    Appendix B

    About the Editors

    About the Contributors


    David Eitel, John M. Shiver

    Much as a surgeon uses a scalpel, retractor, and other tools to operate on a patient, Shiver gives the healthcare manager the tools they need to enhance the function of the Emergency Department, the 'front door' of every community’s health care system. The text is clear, concise and understandable to those lacking a technical background but who still want to apply fairly sophisticated techniques to improving the patient experience and the productivity of ED staff.
    — J. Knox Singleton, President and CEO, Inova Health System

    Optimizing Emergency Department Throughput is a breakthrough in creating a framework for ED transformation. It uses state-of-the-art improvement techniques to solve problems bedeviling America: crowding and delays in critical treatment. Shiver and Eitel offer clear, practical approaches that leaders can use to get results.
    — Bruce Siegel MD MPH, Director, Center for Health Care Quality, Department of Health Policy

    For those physician leaders and hospital administrators who wonder if there are solutions out there for their frustrating overcrowding and flow issues, this book provides a needed introduction to the science of reengineering your health care delivery system. The authors build on decades of experience together with proven models from the literature that will help you move your organization forward, while improving patient and staff satisfaction.
    — Christopher MB Fernandes, Professor of Emergency Medicine, University of Western Ontario/Chair, Medical Advisory Committee, London Health Sciences Centre

    This is a very practical, idea filled book that should be read by any healthcare professional supervising, dependent upon, working in or "sinking" in one of America’s besieged emergency departments. I found myself repeatedly circling, underlining, and writing in the margins throughout the book. In the introduction, Shiver reports that ED’s "are not at a tripping point; they are at a breaking point". The "tools" presented in this book can prevent or at least delay your tumble into that seemingly inevitable abyss.
    — Robert J. Cates MS, MD, Chairman of Emergency Medicine, Inova Fairfax Hospital

    Because the ED is a major gateway to all hospital services, a public health asset, and an economic driver or millstone, Optimizing Emergency Department Throughput is an essential read for all CNEs, COOs and CEOs.
    — Lawrence L. White, Jr. MHA, FACHE, Research Assistant Professor, School of Public and Community Health Sciences, University of Montana