ENHANCING EMERGENCY

DEPARTMENT EFFICIENCY FOR

IMPROVED PATIENT EXPERIENCE
TABLE OF CONTENT
S.NO. TITLE
1. INTRODUCTION
• About Emergency Departments
• Problems
• Initiatives
• Background and Contextual
Information
• Best Practices
• Solutions

2. RESULTS
3. FINANCIAL IMPACT
4. APPLICATIONS
5. FUTURE RECOMMENDATIONS
6. CONCLUSION
7. REFERENCES
 INTRODUCTION
About Emergency Departments (ED):
 As patient volumes and health care complexity increase, emergency
departments remain important care settings for acute and urgent medical needs.
 Overcrowding, prolonged waiting times, and inadequacy of resources within
emergency departments negatively affect quality of care and patient satisfaction.
 Controlling ED occupancy is important for improving quality of care since
the capacities and demographics of patients reveal themselves in unpredictable
admission rates.
 To reduce waiting times, patients' outcome needs appropriate resource
management such as staffing, medical equipment allocation.
 The study (Mostafa and Khaled El-Atawi, 2024) used this approach to apply Fig. 1: Emergency department
(https://www.istockphoto.com/photos/emerg
technology to determine evidence-based strategies for the improvement of ED ency-room)

performance. These focus on admission rates, crowding, and resource

management.
Problem:

1. Inefficient Patient Flow Management: Greater proportion of patients left the ED unsurveyed
because of inefficiencies regarding managing increased demand. It created a problem that
highlighted awareness in better patient flow management concerning issues of efficiencies and
risk management (Rathlev et al., 2017).
2. Overcrowding: Because of variability in patient load, EDs are vulnerable to overcrowding and
resource pressure with heavy deteriorating impacts on care and patient satisfaction.
3. Prolonged Wait Times: Longer waiting times are more associated with higher occupation as
it has a very adverse impact on patient satisfaction and care quality.
4. Resource Limitations: Lack of employees and availability of equipment in the health facility
makes it impossible to provide immediate care (Mostafa and Khaled El-Atawi, 2024).
5. Ineffective Communication: The failure of proper communication from the staff members and
among the patients resulting in patient dissatisfaction and negative perception toward care
(Sonis et al., 2017).
 4 TOP INITIATIVES UNDERTAKEN
1) Expand Telemedicine Services:
-Projected Increase in telehealth visits to 4,500 In 2024.
- Estimated revenue increase: $600,000 (from $300,000 to $900,000).
3) Enhance Ancillary Services:
- Overview: Implement virtual consultations to enhance patient access -Overview: Expand Services such as lab tests and imaging. to
and convenience . provide comprehensive care within the ED.
- Estimated Costs: $100,000. -Increase lab and Imaging services by 20%.
-Projected additional revenue: $540,000 .
- Net Revenue Impact: $500,000.
Benefits: ($1,200,000 X 20% +$1,500,000 x 20%).
-Increased patient satisfaction. -Estimated Costs: $80,000.
-Reduced overhead costs far in-person visits. -Net Revenue Impact: $460,000
Benefits:
•Increased revenue from additional services.
2) Implement a Fast-Track system:
•Improved patient outcomes from timely diagnostics.
-Overview: Create a Streamlined process for low patients to reduce
wait times and improve patient flow.
-Estimated to Increase patient volume by 10% (from 45,000 to 4) Community outreach Programs:
49,500). -Increase outreach awareness and access to services,
-projected to bring in an additional 2,000 patients.
-Projected additional revenue: $1,050,000 (10% of $10,500,000 in
patient billing ). -Estimated revenue Increase: $530,000 (2,000 visits X 265).
-Estimated Costs: $150,000 *Total Projected Revenue Increase from these Initiatives:
-Net Revenue Impact: $900,000. $2,720,000.
Benefits:
•Enhanced operational efficiency.
•Improved patient expert and retention.
Background and Contextual information:
Introduction about Roger Williams medical center ED (RWMC-ED):

The 12,000-square-foot ED at RWMC in Providence, Rhode Island, has:

• 22 rooms, which include three isolation rooms, a FastTrack area, and a trauma room.
• Emergency medical technologies and state-of-the-art equipment.
• Highly experienced emergency physicians and nurses.
• A new design for patient flow and triage.
• Cozy waiting room with a countertop Wi-Fi area.
• Enhanced security and safety technology.
• RWMC is open seven days a week, twenty-four hours a day.

Boston University School of Medicine is affiliated with RWMC, an academic medical center. It is known to be well-
recognized for its services in gastroenterology, cancer care, and elder care. It is also recognized for providing quality services.
Another program, that is solely available at RWMC, is the state's bone marrow transplant program.
 Background and Contextual information:
1. Rathlev et al., (2017) study focuses on:
 Efficiency and Risk Management in the ED: No care for
patients is an important indicator of efficiency and a sign
of problems with risk management.
 Productivity Metric: There are the number of patients
treated by the providers, which would reflect ED
productivity and demand management.
 Post-Expansion Demand: The newest emergency
department was opened in December 2012. Leave rates
also experienced an increase as well as in patient
demand.
 Operational Structure: The previous nursing leadership
Fig. 2: Patient flow
lacked structure, which resulted in the poor management (https://dropstat.com/blog/healthcare-management/improving-patient-
flow/)
of ED flow.
 Background and Contextual information:
2. Whereas, Mostafa and Khaled El-Atawi, (2024) focuses on:
 Critical Challenges: Overcrowding, lack of available resources, and an ever-increasing
demand for patients are some of the critical issues regarding EDs.
 Essential Role: Despite long wait times and patient satisfaction rates,
emergency departments are of critical importance in the treatment of acute cases.
 Need for Improvement: Which indicates the necessity of improvement to achieve
resource allocation maximization and enhanced patient throughput by adopting
effective strategies.
 Evidence-Based Approach: This study relies on measurable performance points
through waiting times and satisfaction, based on observational data and Fig. 3: Power of Patient Satisfaction
https://www.practicebuilders.com/blo
literature. g/20-effective-and-surefire-ways-to-
 Technological Integration: It addresses how telemedicine and electronic health records improve-patient-satisfaction/

(EHRs) can improve the quality and operational effectiveness of care.

 Multifaceted Solutions: Advocates for an integrated approach of technological and
organizational advancement to solve the pressing health problems for better patient care.
Background and Contextual information:
3. At the end, Sonis et al., (2017) focuses on:
 Importance of ED Patient Experience: The ED experience is pivotal to the quality of
overall care because most patients visiting the ED for the first time will have an
experience which may determine their perception on whether to return to the same facility
or not.
 Systematic Review Results:
• Communication: Satisfaction among patients is highly reliant on sensitive and
clear communication between staff and patients.
• Wait Times: Among the most important measures to enhance patient satisfaction
is reducing the waiting time.
• Staff Empathy: Patients, when they visit an emergency department, must be supported
and cared for, mainly depending on the staff's empathy.
 Call for Improvement: The quality of care should improve through improving
empathy and communication in EDs.
Best Practices:

Technolog Lean Improved Culture of Standardized Proactive Strong

Advance Fast-track Flexible
y Management Communic Continuous Treatment Pain Discharge
Triage Systems Staffing
Utilization Principles ation Improvement Protocols Management Planning

Fig. 4: Patient Experience

https://www.newmetrics.net/insights/enhanci Fig. 5: Improvement in patient flow
ng-patient-experience-for-improved- https://dropstat.com/blog/healthcare-
healthcare/ management/improving-patient-flow/
 Solutions:
1.Institute Rapid Triage and Assessment: Develop processes for rapid assessment of patient acuity to direct which patients should be
seen first.
2.Use Point-of-Care Testing (POCT): Use POCT to reduce time to laboratory results by providing point-of-care testing whenever
feasible, enabling testing at the bedside of the patient.
3. Employ Predictive Analytics: Employ predictive analytics to predict patient flow and staffing needs at peak periods.
4. Improving Communications: Coordinate and harmonize better among ED staff and other departments
5. Lean Management Principles: Applying lean principles to eliminate inefficiencies in patient flow and care delivery
6. Fast-track designs: Reduce wait times by bringing in 'fast-track' lanes for patients with minor illnesses.
7. Standardized treatment protocols: Ensure immediate care through standardized treatment of common conditions.
8.Implement Pain Management Procedures Better: Employees should be trained on pain management techniques early and be
given prompt pain assessment.
9.Use Telemedicine: Telemedicine must be utilized to maximum in person resources such as follow-up treatments and non-
emergency patients can be managed through telemedicine.
10.Discharge Planning: Creation of scheduling and smooth discharge procedure for follow up appointments would ensure
continued continuum of care.
 FINANCIAL IMPACT
More Income: The patient
Less Expensive: The Less Lost Revenues: Further Patient Satisfaction: Reduced
volume is higher in case of 299
optimized roles reduce lost revenues chances are waiting times and efficiency
patients as compared to 265
operational cost immensely by reduced when the walk-out levels get a more satisfied
patients treated per day, thus
nullifying extra spending on percentages decline from 8.2% patient group, with retention in
the revenue generated through
any form of staffing. to 4.5% of total patients. it.
care services is higher.

Reduced Readmission Rates:

Risk Management: With Cost Saving Efficiency: With Shorter Length of Stay:
The effective discharge planning
fewer patients going home efficient processing of patients, Effective management makes
helps in improving the care of a
without care, bad outcomes and fast track and triage systems the patient's stay in hospitals
patient and reduces treatment
subsequent litigation occur less lead to decreased per unit of shorter. This leads to fewer costs
costs through reduced
frequently. operation costs. per patient.
readmission rates.

Optimized Personnel Costs:

Potential More Funding:
Predictive analytics ensure that
When efficiencies are proven,
the correct personnel are
the government and health
assigned to match demand, thus
payers are likely to provide
saving overtime and increasing
additional funding.
the productivity of workers.
 APPLICATIONS
Charger positions, such as charge nurse, lead nurse, and pod nurse, need to be improved over
1. flow coordinators for maximum throughput and ideal ED.

Optimization of Available Roles: Rather than recruiting new employees, optimizing

2. your available human resource will increase productivity and efficiency.

Data Analysis: Through the analysis of patient flow data by using both linear and
3. fractional logistic regressions, insights will be gained to inform performance
tracking and development.

Reduced Waiting Time: Systematically eliminate the number of patients who are
4. being discharged. The patient satisfaction and risks will be reduced.

Triage with Quickness and POCT: Applies POCT for quick diagnosis and quick
5. triage enables prioritizing of the assessment.

Fig. 6: Healthcare Information Management Lean Management Principles: Systems for smaller cases are being designed and
https://www.sumasoft.com/blogs/bpm-
6. patient processes are identified and removed with lean management principles.
services/healthcare-info-management-important-
aspect/
Continuous Improvement: Enhance patient care and communication through further
7. discharge planning, telemedicine follow-ups, and training the staff.
 ROI
1,200,000

Total Projected Financial Impact: 1,000,000

• Total Projected Revenue Increase: $2,720,000 .
800,000
• Total Estimated costs: $380,000.
•Total Net Revenue Impact: $2,340,000 . 600,000

400,000
Conclusion:
•High ROI: The proposed initiatives yield a projected ROI of 200,000
615.79%, demonstrating a significant return on Investment .
0
•Strategic Growth: Implementing these initiatives will not only s m s s
i ce te i ce ra
m
enhance financial performance but also improve patient care and rv ys rv og
Se kS Se Pr
operational efficiency e ac ry
cin T r la ch
ed
i
st- ncil re
a
a A t
l em tF e Ou
Te en a nc ity
an
d em En
h un
p pl m
E x Im m
Co

Projected Revenue Increase Estimated Costs

Net Revenue Impact
 OPPORTUNITY COST
Definition: Opportunity cost refers to the potential benefits lost
when choosing one alternative over another. It of highlights the
1,200,000
revenue and operational Improvements. RWMC ED may for felt
by not implementing the proposed Initiatives. 1,000,000

Total Opportunity Cost of Inaction : 800,000

• Total Projected Revenue Increase: $2,720,000 . 600,000

• Total Estimated costs: $380,000.
•Total Net Revenue Impact: $2,340,000 . 400,000
• Total Opportunity Cost of Inaction: $2,565,000 . 200,000

Consequences of Inaction: 0
s m s s on
•Missed Revenue: Failing to implement these initiatives results i ce ste i ce ra
m ti
rv y rv og iza
Se kS Se Pr tim
in a potential loss of $2,720,000 In additional e ac r y
i cin Tr ill
a
ac
h Op
Revenue. ed st- c
tre ng
a An affi
l em tF e O u
St
•Operational Inefficiencies: Continued high wait times and Te en a nc ity
d e m h un
patient dissatisfaction could lead to decreased patient volume pan pl En m
E x Im m
and further revenue loss. Co
• Competitive Disadvantage: Not adopting innovative gift to Projected Revenue Increase Estimated Costs
practices like telemedicine may hinder RWMC ED'S ability to Net Revenue Impact
compete with other healthcare providers.
 NPV
Definition: Net Present value (NPV) is a financial metric used to
evaluate the profitability of an investment by calculating the 3,000,000
difference between the o present valve of cash inflows and
outflows over time. A positive NPV Indicates that the projected 2,500,000
earrings (in present dollars) exceed the anticipated costs.
2,000,000
Total NPV Calculation :
•Total Present valve of cash Inflows: [2,125,000+2,245,000
+2,042,000 + 1,855,000+ 1,688,000 = 10,955,000]. 1,500,000
•Total Present Valve of cash outflows:[380,000 (1year only)
=380,000] . 1,000,000
•NPV calculation: 10,955,000-380,000 =10,575,000 .
500,000
Conclusion:
•Positive NPV: the NPV of $10,575,000 indicates that the
proposed initiatives are expected to generate substantial Valve 0
1 2 3 4 5
for RWMC ED over the next 5 years .
• Financial viability: A positive NPV supports the financial Cash Inflows (Revenue Increase) Cash Outflows (Costs)
Series3 Series4
justification for Implementing these initiatives, highlighting their Series5
potential to enhance revenue and operational efficiency .
 BREAK-EVEN ANALYSIS
Fixed Variable Price per Break-
Initiative costs costs per unit even
unit Volume
Definition: Expand $100,000 $50 $150 667 Visits
The break-even point is the point at which total revenues Telemedicine
equal total costs, resulting in nether profit nor loss. Services
Implement $150,000 $75 $150 2,000
Fast-Track Visits
System
Conclusion: Enhance $80,000 $30 $100 800
Highlight the importance of reaching the break-even point to Ancillary Services
ensure financial sustainability. Services
Community $50,000 $20 $100 500
Outreach patient
Programs
Staff $0 $0 N/A N/A
Optimization
 COST-BENEFIT ANALYSIS
Total Total Net Benefit-
Initiative costs Benefits Benefits cost Ratio
Expand $100,000 $600,000 $500,000 6:1
Telemedicine
Overview: Services
A comparison of the costs of Implementing each initiative Implement $150,000 $1,050,00 $900,000 7:1
against the expected benefits. Fast-Track 0
System
Enhance $80,000 $540,000 $460,000 6.75:1
Ancillary
conclusion: Services
Emphasize the strong benefit-cost ratios, Indicating that the
benefits significantly outweigh the costs. Community $50,000 $530,000 $480,000 10.6:1
Outreach
Programs
Staff $0 $225,000 $225,000 N/A
Optimization
 SENSITIVITY ANALYSIS

Overview: Assumption Base case Scenario1 Scenario 2

An analysis of how changes in key assumptions (e.g., patient (10% Increase) (10% decrease)
volume, reimbursement rates) . Impact the financial outcomes.
Patient 45,000 49,500 40,500
Volume
Revenue $2,720,000 $2,992,000 $2,448,000
Increase
Conclusion:
NPV $10,575,000 $11,500,000 $9,650,000
Highlight the robustness of the financial projections under
varying scenarios. ROI 615.79% 685.00% 550.00%
 FUNDING REQUIREMENTS

Initiative Total Funding Potential Funding

Required Sources
Overview:
outline the total funding needed to implement the proposed Expand $100,000 Grants, Internal
Telemedicine Budget
initiatives and potential sources of funding.
Services
Implement $150,000 Hospital Funds ,
Fast-Track System Partnerships
Enhance Ancillary $80,000 Revenue
Conclusion: Services Reinvestment
Discuss the feasibility of securing the required funding and Community $50,000 Donations , Grants
the strategic importance of each initiative. Outreach Programs
Staff Optimization $0 N/A
 RISK ANALYSIS
Initiative Potential Risks Mitigation Strategies

Overview: Expand Telemedicine Low adoption by Marketing campaigns,

Identify potential risks associated with each Services patients. Patient education.
Initiative and strategies for mitigation.
Implement Staffing shortages Flexible scheduling,
Fast-Track System cross-training.

Conclusion : Enhance Ancillary Equipment failure Regular maintenance

Emphasize the Importance of proactive risk Services Backup systems.
Management to ensure successful Implementation.
Community Outreach Low community Collaborate with local
Programs engagement organizations

Staff Optimization Resistance Staffing Training and

to chart involvement
 RECOMMENDATION

Strategic Recommendations:

Implement Proposed Initiatives :

-Expand Telemedicine services: Leverage technology to Increase patient access and satisfaction, while generating significant revenue
-Implement Fast-track system: Reduce wait times and improve patient flow, enhancing overall operational efficiency.
-Enhance Ancillary Services :offer additional services that complement emergency care, providing convient for patients and increased
revenue.
-Community outreach Programs: Strengthen community ties and Increase patient volume through targeted heath education and
outreach Initiatives.
-Staffing Optimization: Improve staff allocation and training to maximize productivity and reduce burnout.

Financial Justification:
High ROI: The proposed initiatives collectively yield a projected ROI of £15.79%, demonstrating a strong financial return on
Investment.
Positive NPV: With an NPV of $10,575,000, the Initiatives are expected to generate substantial Valve over the next 5 years.
 REFERENCES
Mostafa, R. and Khaled El-Atawi (2024). Strategies to Measure and Improve Emergency Department Performance: A
Review. Cureus. [online] doi:https://doi.org/10.7759/cureus.52879.
Rathlev, N.K., Anderson, J., Schmidt, J., Hettler, J., Garreffi, L., Gray, M., Neal, D. and Visintainer, P. (2017). Key Players in Key Roles: The
Baystate Patient Progress Initiative to Improve Emergency Department Efficiency and Productivity. Journal of Emergency Nursing, [online]
44(2), pp.123–131. doi:https://doi.org/10.1016/j.jen.2017.10.015.
Sonis, J.D., Aaronson, E.L., Lee, R.Y., Philpotts, L.L. and White, B.A. (2017). Emergency Department Patient
Experience. Journal of Patient Experience, [online] 5(2), pp.101–106. doi:https://doi.org/10.1177/2374373517731359. Treatment Advocacy
Center -. (2024). Home | Treatment Advocacy Center. [online] Available at: https://www.tac.org/ [Accessed 27 Oct. 2024].
Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic
review of causes, consequences and solutions. PLOS ONE, 13(8), e0203316. https://doi.org/10.1371/journal.pone.0203316