Many of the hospital’s admissions come through the Emergency Department (ED). Because of EMTALA, the hospital is required to perform a medical screening exam, but the truth is that our physicians will treat the patient as well. Many of the patients who aren’t admitted will come back for further outpatient treatment, either directly or because they were referred to a specialist on the hospital’s staff.
So how can the traditional loss leader become less of the loss and more of the leader? The complexities of the ED need to be considered in light of improved tools, processes and functions. The formula may sound easy, unless you have been trying to work through the process yourself.
Furthermore, the results in the ED are highly integrated with a group of independent, emergency physicians. Their concerns aren’t always the same as the hospital’s, yet there needs to be an understanding and agreement for how specific issues should be handled, such as staffing, support agreements, record handling and patient care policies. These are the very physicians who may see a return patient for no charge and will decide who should be admitted to the hospital, transferred or sent for Observation.
Barriers to Improving Operating Results
Staffing with well qualified staff, 24/7, has been a hurdle for ED directors for some time. Heightened hurdles include the responsibilities of how to handle Observation and related care in a timely fashion while requiring the documentation, controls over charge capture and appropriate coding. This is often the goal, but without the resources for an initial, detailed assessment required to understand and set the stage for ongoing improved performance, it won’t be achieved.
Approach to Improvements
By working with the clinical flow of the ED, and evaluating and updating the tools (e.g., charge master, medical records, forms, policies and procedures, and an improved charging methodology), we are better able to resolve the conflicts and provide options for how others have been able to improve results. We add to this mix, the realization that meeting the goals also means we need to minimize the issues and daily hurdles.