Throughput in the Emergency Department: a Concept Analysis

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ED THROUGHPUT 2
Introduction
A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly population (Clinical Advisory Board, 2008). In response to these issues, hospital administrators are challenged to evaluate patient flow and identify opportunities to improve process strategies within the ED. This is where throughput evolved in healthcare and became the new buzzword for patient flow. In healthcare, throughput refers to the ED process that impacts patient flow (Jarousse 2011). The purpose of this concept analysis will be to explore throughput and discuss how it is critical for survival in the ED and beneficial to the overall financial success of the hospital. Significance of the Concept

In today’s consumer driven healthcare, quality patient outcomes and high scores in customer satisfaction define a successful hospital. EDs must deliver excellent and efficient care to achieve these outcomes. Throughput is the basic concept to meet these categories. Weak patient flow models create dissatisfied patients, poor patient outcomes due to slow service, frustrated staff, and diminished bottom lines (Jensen & Crane, 2008). Clinical quality is at risk by delay in time sensitive treatment and wait times extended so long that a growing number of patients leave without being seen (LWBS). Suboptimal throughput can also have devastating outcomes on hospital finances by decreasing the number of inpatient admissions coming from the ED, diversion to other facilities, and again increase in LWBS. Low customer satisfaction scores can affect the entire organization financially by the ED THROUGHPUT 3

consumer choosing another hospital for their services long term (Clinical Advisory Board, 2008). The ED is the hospital’s “front door.” It is imperative that the ED gives the patient the first and most lasting impression of the quality the organization has to offer (Jensen & Crane, 2008). ED throughput remains a hot topic for all acute care hospitals in 2011. Excellent throughput times in ED will increase patient satisfaction scores, reduce malpractice risk, and increase hospital revenue through higher patient volumes and charge capturing (Phoenix Physicians, n.d.). Literature Review

During the 1990’s, reducing inpatient stays had become a major focus for hospitals in the United States. Medicare’s prospective payment system drove home to nursing the reality of financial limitations to quality patient care (Farren, 1991). Many hospitals were challenged with the need to decrease length of stay (LOS) and total cost to maintain a positive operating margin under a diagnostic related group based reimbursement system (Rachoin, Skaf, Cerceo, Fitzpatrick, Milcarek, Kupersmith, & Scheuer, 2012). As overcrowding and wait times increased in the ED, so did the focus on LOS of visits of ED patients. The word throughput was utilized out of necessity through attempts of decreasing LOS in ED. During the literature review, this author identified five definitions of throughput from at least three different disciplines. The origin of the word is defined from 1920-25; from the phrase put through modeled on output (Throughput, n.d.). Computer science defines throughput a couple of different ways. One is the rate at which a processor can work expressed in instructions per second or jobs per hour. A second example is the...
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