Patient Safety and Quality

Learning networks can help implement strategies to improve emergency department patient flow

Many emergency departments (EDs) are operating at or above capacity, which can negatively impact care quality. In response, hospitals have implemented strategies to improve patient flow and reduce ED crowding. A new study identifies the facilitators and barriers encountered by six hospitals that implemented various strategies to improve patient flow. It found that participation in a learning network and strategic selection of improvement team members facilitated implementation. Other facilitators included executive support and the availability of resources; staff-driven improvement strategies; an aligned reporting structure; implementation of simple process changes; and a flexible and robust information technology system.

Factors impeding implementation included staff resistance and entrenched organizational culture. Staff resistance most often occurred when process changes resulted in more work or a disruption in workflow, or because frontline staff were not included in the planning. Organizational resistance was more likely when a proposed change ran counter to the existing culture, note Dina Moss, M.P.A., of the Agency for Healthcare Research and Quality, and coinvestigators. Some of the challenges were mitigated through approaches such as staff education and department leaders' constant reinforcement.

All six of the hospitals were members of an 18-month Urgent Matters Learning Network that implemented a total of eight different strategies. The strategies were: protocols for specialty consults; advanced protocol for patients presenting with abdominal pain; standardized registration and triage process; 5-level triage; immediate bedding; fast-track improvement using dedicated beds for fast-track patients; mid-track process for mid-acuity patients; and ED/inpatient department communication improvement. The study's findings were based on two rounds of interviews with members of hospital implementation teams, with a total of 129 interviews.

See "Facilitators and barriers to the implementation of patient flow improvement strategies," by Kevin J. Van Dyke, M.P.P., Megan McHugh, Ph.D., Julie Yonek, M.P.H., and Ms. Moss, in the Quality Management in Healthcare, 20(3), pp. 223-233, 2011. Reprints (AHRQ Publication No. 12-R031) are available from the AHRQ Publications Clearinghouse.

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