PV: So your first assumption was that this was due to influx of emergency patients?
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ACEP Now: Vol 35 – No 11 – November 2016EL: Absolutely. It was based on the common sense for two reasons: First, the volume is the highest among all admits, and second, it’s unpredictable by its nature. Elective admissions are smaller in terms of the volume, and their schedule is up to us. Unfortunately, our health care delivery is not always based on common sense.
PV: What did you find?
EL: It was impossible for Dr. Long and me to get the data from emergency departments. Nobody wanted to share the data with us. However, we were able to get the data from one operating room. Two transparencies were on the desk in front of us. One of them was bed occupancy, and the other was surgical volume. We found they were overlapping. They had about the same shape. So if you put it up to the window glass and overlap one over another to compare, we found that they practically coincided. That was for me a real aha moment: Emergency department admissions had very little to do with variability. Since then, for years I have talked to many hospital emergency department leaders asking, “Five Tuesdays from now, short of a bus crash or flu epidemic, could you predict approximately how many patients are going to be admitted to your emergency department?” The answer was always yes. Then I asked many operating room managers the same question: “Five weeks from now on Tuesday, how many surgeries are you going to perform?” Given that typically over 70 percent of all surgeries performed are elective, I was very surprised to find out that people cannot answer this question. That, to me, was clear evidence regarding the source of this variability. Of course, this was not just the surgical admissions. This is true for the other elective admissions, eg, cath lab.
PV: Do you find this to be true at most institutions?
EL: Practically everywhere. In dozens of hospitals where I asked this question, the answer was the same. It’s not just in the United States. It’s true in Europe, Canada, you name it. It looks like an international plot against health care cost and quality and the main driver of capacity problems.
PV: In response to this, there were three things that were implemented that we refer to as smoothing: separating out the emergency surgical flow from the elective surgical flow, smoothing the number of surgeries over the week, and also smoothing them to predict the number of ICU beds needed.
2 Responses to “To Reduce Emergency Department Boarding and Hospital Crowding, Look Beyond the ED”
November 29, 2016
Kurt KnochelOn October 18, 2016 Cincinnati Children’s hospital board of trustees approved construction to increase beds by 33%. Here is link: http://www.cincinnati.com/story/news/2016/11/10/cincinnati-childrens-boost-beds-33/93598474/
This directly contradicts the interview.
December 8, 2016
Eugene Litvak, PhDThe following three links contain the relevant data:
1. “Improvements in efficiency have boosted our capacity by the equivalent of a $100 million, 100-bed expansion and increased income from treatment of patients by even more” at http://www.jointcommissioninternational.org/assets/1/14/MPF09_Sample_Chapter.pdf (PDF,
page 111).
2. “No waiting: A simple prescription that could dramatically improve hospitals — and American health care” at http://www.boston.com/bostonglobe/ideas/articles/2009/08/30/a_simple_change_could_dramatically_improve_hospitals_ndash_and_american_health_care
3. “James Anderson, adviser to the president at Cincinnati Children’s Hospital, said IHO helped that hospital improve revenues by 34 percent and avoid spending $100 million on a planned patient tower it no longer needed. Anderson, the hospital’s former president and CEO, said waiting times in the ER and OR also dropped.” Available at ttp://www.chicagotribune.com/lifestyles/health/sc-eugene-litvak-health-0504-20160502-story.html
As you can see from the above materials, these changes have been implemented 10 years ago and saved $100 million in avoided capital cost alone. I would assume patient volume increased since then. I would be unreasonable to state that this (or any other) intervention eliminates bed needs FOREVER.