Checklist for the ideal emergency department

The emergency department (ED) is a busy and dynamic department, providing a broad range of care, from acute to non-acute, 24/7. Yet due to a fluctuating patient flow, properly planning staff and resources can be challenging. So how do you ensure that your ED can handle the healthcare demands now and into the future? We recently organized a round-table session with doctors and nurses to come up with a blueprint for the ideal ED.

In the first article of this series, we address several of the most important considerations of an ideal ED and in the second one we cover the ED layout. In this third article, we combine the ideal blueprint with our field expertise to help determine what is actually feasible in practice. We used this knowledge to create a checklist indicating initials steps to take towards your ideal ED.

Working toward the ideal ED

Whether you are designing an ED department from scratch or making changes to the existing building structure, there are several things that you must consider. We have compiled a checklist covering the most important items, so you can make an initial assessment of areas that require changes or improvement. Obviously, things tend to be more complex in practice, but our intention is to give you a starting point for the optimization process.

Focus on your ED

Check what applies to your department. This involves looking at the ideal situations that are already in place in your ED. If the department is running well, you should be able to add quite a few check marks.

Optimal processes, inside and outside the ED

• The different patient groups (acute, non-acute and self-referrals) arrive in the ED separately
• Clear work processes are in place with other hospital departments, such as acute admissions and radiology
• These work processes are followed and issues rarely arise
• The triage turnaround times are met without any difficulty
• ED staff and ambulance teams work closely together
• Coordination runs smoothly, ensuring the incoming patient flow is under control
  

Efficient use of satisfied staff

• Operational responsibilities for ED staff are known and clear. These responsibilities underpin processes designed to ensure that staff can work efficiently
• ED staff regularly indicate verbally that they are satisfied with their workplace and this is reflected by a low sickness rate
• Recovery time for ED staff during and between shifts is a priority
• Coordination within the ED is well arranged, indicating that everyone—doctors, nurses, and assistant doctors—know what is expected of them. The department is well organized and there is a sense of professional calm, even during busy periods

Technology

• Technology is used to give a real-time overview of available beds, so everyone concerned knows the exact available ED capacity. This helps to manage the flow of incoming patients
• We use retrospective analyses of patient numbers to forecast the incoming patient flow to the ED and tailor capacity accordingly
• The ED layout is flexible, so we can treat different types of patients in all rooms. We can adjust levels of light, sound and smell to the target group in question

What next?

Once you have gone through all the points, look at the ones you have not checked off. Can you do a thorough cause analysis of the most urgent issues? This will help you to map why your ED falls short of the ideal situation on those specific points. You can then move onto areas of improvement and the changes needed.
 

At Philips Healthcare Transformation Services, we use data combined with observations and interviews to conduct a root cause analysis. In some cases, the actual problem may have more than 100 causes. We map the steps you need to take to move from current to ideal situation. Having a clear picture of the future state is an essential part of this effort. We utilize data simulations and test scenarios based on predictive data, and work with experts in the field of (new) construction. This approach, results into the ideal ED department for you.