How can an emergency department (ED) be set up to handle an increase in patient intake? This was the primary question during a round-table session attended by a group of experienced doctors and nurses invited by Philips Healthcare Transformation Services. The guiding principle of the afternoon was the idea that the design of a new ED must be substantially based on data. By making well-founded predictions now, you can ensure that your ED will be able to guide the flow of acute care patients through the care process for years to come. This first article of a three-part series, reflects the topics discussed and the input of the participants during the round-table. The second article addresses the ideal ED layout and in the third article, we provide a checklist indicating initial steps to take towards your ideal ED.
The ED is the easiest-to-predict department in the entire hospital
Big data allows us to detect patterns of patient intake in the ED. It is likely that all hospitals will have a similar pattern: The daily patient intake is shaped like a whale, peaking in the afternoon. We can use data to accurately predict how many beds will be required for emergency admissions in the coming months. Patients appear to visit the ED randomly, but the hospital can still anticipate the numbers, allowing for improved throughput. This makes it possible to better align bed schedules for elective and emergency patient flows.
Next to retrospective data, it is also important to have real-time insight into bed space, patient locations and the status of diagnostic services. Real-time insight makes it easier to predictively manage smooth throughput in the ED. This can be achieved using innovations that provide reliable real-time data while minimizing the administrative burden.
Patient experience vs. quality of care
Is experience of care more important to the modern patient than quality of care? A positive patient experience is certainly a plus when assessing the services provided in the ED. Furthermore, a positive experience can contribute to the patient's recovery and staff's working experience. However, the average patient is more likely to assess their experience of care than the quality. Meanwhile, for care professionals, providing high-quality care is always the primary focus.
The ideal ED takes both patient experience and quality of care into account. To make the experience of care as positive as possible, the space can be set up differently for each patient group, based on the care need. This means that the layout, light, sound, color and even smell will be different for high care, medium care, low care and short stay.
The ideal ED is both spacious and compact
The ideal ED should be compact. This allows for better observation and reduces the walking distance between high care and low care. It requires a square-shaped or circular ED with management based at the center.
At the same time, there is sufficient room for staff to move around without getting in each other's way. Patient flows should be separated. If the hospital does not have the space, it will be necessary to intersect patient flows, because some diagnostic services such as radiology are only available in one location. In larger hospitals, the option of doubling up services can be considered to separate patient flows, for example by having X-ray facilities available in low/medium care and more complex imaging in high care.
Finally, there should be sufficient space for patients — currently as well as in the future. To gain more insight into this, using simulations of future scenarios with different numbers of visitors can be a valuable resource. These simulations will "test" the design of a new ED. It is important to know in advance exactly which patient groups the ED will service—now and in the future—the size of these groups, and what is required in terms of space for triage, treatment and possibly any observation of these patients. In the second article of this three-part piece we address the ideal ED layout and in the third article we provide a checklist indicating initial steps to take towards your ideal ED.