Every emergency department (ED) strives to attain an optimal level of effectiveness, while trying to achieve its valid patient care mission. There are numerous factors that affect the departmental operation. The most prominent issues obviously include the patient number, acuity and rapidity of presentation, balanced by staff and bed availability—both in the ED—as well as hospital admission bed vacancy.
An important consideration is that these factors are intimately intertwined so that a delay in one portion of the care chain involves other aspects of care as well.
The key to emergency medicine is “parallel process thinking” rather than series patient management (Figure 1). This concept is analogous to the physics of electrical circuitry allowing an alternative pathway for delivery if an impedance to flow is encountered. This attribute allows multiple tasks to be addressed simultaneously rather than sequentially.
Figure 1. Patient Management
Empowering each member of the staff to contribute and offer insight to the process will pay long term dividends to the institution. The “Team Approach” for all health care providers encourages tangible participation and “buy in” to the process. The quickest way to disenfranchise the group is to offer oversight and protocols without their input into the patient care process they perform involved in this care.
The best-run emergency departments, therefore, provide a proper balance of effectiveness of patient care accompanied by the maximization of the efficiency of the health care delivery system providing that care.
The consultation industry has a tendency to focus on efficacy with a theoretic constructive of work output that is untested—an abstract goal, if you will. This concept is in contrast to effectiveness or the actual work product in real life working conditions (Figure 2).
Figure 2. Work Productivity Measures
Therefore, the reference point for effectiveness must be contemporaneous actual clinical experience. Occasional observations of work interactions that are in the distant past are not productive or accurate.
Lastly, the concept of efficiency balancing the work product with the resources consumed is the most critical analysis point for the discussion.
This philosophy is tempered by the incorporation of a service excellence customer service model addressing the two areas of most concern: the timing of the visit and the amount of “caring” exhibited by the staff.1
This approach culminates in the “maximally efficient emergency department,” providing both optimal patient care and customer-focused efficient care delivery (Figure 3).
Figure 3. Optimal Balance
1. Vukmir, R.B. “Customer satisfaction.” International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services 2006; 19(1): 8 – 31.