There is huge value to timely data collection and sharing within an individual emergency department and between emergency departments.

Several national surveys create a statistical picture of the emergency system in America, including the National Hospital Ambulatory Medical Care Survey, which covers 1992–2016, and the annual Emergency Department Benchmarking Alliance (EDBA) survey, which has reported on ED performance measures since 1994.^1,2

The National Emergency Department Inventory (NEDI)-USA database is maintained by the Emergency Medicine Network (EMNet) at Massachusetts General Hospital in Boston.³ NEDI-USA contains data on all U.S. emergency departments, including hospital-affiliated satellite freestanding emergency departments (FSEDs) and autonomous FSEDs. According to NEDI-USA, there were 5,381 U.S. emergency departments that collectively managed 155,946,509 visits in 2016. Within NEDI-USA, all U.S. emergency departments can be found in the free smartphone app EMNet findERnow, including specific information such as total annual ED visit volume and whether the hospital is a verified trauma or burn center.

But creating a national picture has only a small value to emergency physicians and their patients compared to a comprehensive understanding of local needs and services. And local data has the greatest value when it is used for emergency planning, problem-solving, and solution creations at the local level. Emergency department leaders, emergency physicians, and nurse managers must have useful, well-defined data and the context to understand and utilize it. Having systems programmed to collect the data allows managers to build an understanding of the results, put the results in context and trends, and utilize the results and trends to compare their site with similar emergency departments. Data snapshots and trend lines allow hospital administrators to make good decisions to support evolving ED operations and address issues like flu surges and seasonal volume changes.

Using a well-constructed set of site data, ED leaders can identify effective processes and initiate a system for continuous process improvement. A comprehensive view of the emergency department has about 20 operating statistics. ED leaders collect these numbers from the hospital operating and financial systems—and increasingly from digital management systems in the emergency department.

The 20 ED performance measures (see Table 1) are the basis for effective department discussions and leadership. In short, they help answer these questions:

• Who are the patients?
• How effective are ED processes?
• What diagnostic services and treatments are needed for quality care?
• What are the outcomes for patients, ED staff, and the hospital?

All elements serve as the basis for continuous process improvements.

Using Your Data to Improve Your ED

The first, and most important, use of data is to inform the ED staff about the patients they serve and the key performance indicators for that emergency department. Table 2 is a sample staff information chart. These “patient per day” measures are the basis for effective ED management and should be posted in the staff lounge and bathroom (the most important communication site in most emergency departments). Smart ED leaders also understand what measures change on certain days (Monday in most emergency departments) and will recognize that staffing and operational changes are needed for days where predictable patient surges will occur.

Table 1: ED Performance Management Measures

Note: The definitions of these data points are in the literature.² The process for analysis of these data is summarized in an article by Shari Welch, MD, FACEP, and in ongoing Benchmarking and Special Ops articles in ACEP Now.⁴

The personnel and financial descriptors of acuity and the ED service are often shared at department meetings but not on a public chart. Those ultimately reflect on the longevity of ED managers. If ED staff and patient satisfaction are not high, a new group of managers may be analyzing the measures at future staff meetings.

The 20 numbers concept is used in other industries. The performance literature from other industries can be applied to some ED operations, but administrative decisions that affect ED performance must be driven by the demand for high-quality care and patient safety. The 20 numbers provide data to measure the successful execution of the emergency care mission. 

Table 2: A Day in Our ED

References

1. Rui P, Kang K, Ashman JJ. National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables. 2016. Centers for Disease Control and Prevention website.
2. Wiler JL, Welch S, Pines J, et al. Emergency department performance measures updates: proceedings of the 2014 Emergency Department Benchmarking Alliance consensus summit. Acad Emerg Med. 2015:22(5):542-553.
3. 2016 National Emergency Department Inventory – USA. Emergency Medicine Network website.
4. Welch SJ, Augustine JJ, Dong L, et al. Volume-related differences in ED performance. Jt Comm J Qual Patient Saf. 2012:38(9):395-402.