The Emergency Department (ED) may have a reputation for being the hospital's money-losing
department, but it deserves considerable attention because it generates approximately half of
hospital admissions and 45 percent of a hospital's overall revenue. As the front door to the
hospital, the ED is often the first impression patients have of a facility, its staff and the
quality of care it provides.
By removing process bottlenecks and implementing healthcare IT systems, EDs are saving
millions and improving financial performance while delivering better care to their patients. Below
are seven areas where these efforts are paying off in a big way in EDs across the country.
1. Improved access to critical data. The ED is time-pressured, work-intensive and
data poor. However, as more healthcare information exchanges (HIE) expand and mature, they are
giving ED providers better access to critical data. For example, having access to a patient's
recent test results and treatment from another facility for a similar complaint reduces unnecessary
resource utilization.
2. Standardized care plans and order sets. Many EDs are standardizing order sets
and nursing care plans to help providers follow standard guidelines for care and eliminate
unnecessary procedures and tests, resulting in significant cost savings. Computerized Physician
Order Entry (CPOE) systems can also reduce the incidence of orders being placed for unreimbursed
testing, and can capture additional information that makes reimbursement more likely (e.g., reason
for radiologic studies).
3. Electronic prescribing. A study by MGMA's Group Practice Research Network
estimated that the cost spent managing unnecessary administrative complications related to
prescriptions amounted to approximately $15,700 annually for each full-time physician.
E-prescribing offers the potential to lower drug costs and improve patient compliance and
satisfaction.
4. Decision support. Clinical decision support (CDS) systems help providers rule
out certain diseases and illnesses without running a battery of unnecessary tests, provide access
to the latest standard treatment protocols, and help move patients through the ED faster and more
cost-effectively.
5. Documentation feedback. Many EHRs prompt clinicians when documentation is
incomplete. This feedback helps providers create complete, thorough documentation, which results in
better charge capture and optimal reimbursement, and reduces medico-legal exposure.
6. Case management. More frequently, hospitals are providing ED case management
intervention to develop plans for frequent utilizers of the ED and to streamline care transitions.
Case management can reduce the probability of costly and unnecessary readmissions. Access to
real-time information through the EHR is critical to case management program success. In
addition, remote access can provide a scalable solution for case management resource utilization
and sharing across facilities.
7. Referral management. Referral management systems are ensuring patients get the
necessary follow-up care after discharge by letting primary care physicians (PCPs) know when their
patients were seen in the ED and providing a copy of the patient's ED record. In addition, these
systems can also connect patients who do not have a PCP via a referral to a physician within the
hospital's network.
Efforts to eliminate inefficiency in the ED through process improvement and technology are
picking up steam. However, hospital executives cannot expect EDs to fix problems on their own. It
must be recognized that the ED is not a silo; every other department impacts its operations, and
many factors remain well outside its control, including access to primary care providers and
hospital overcrowding. Ultimately, for their efforts to succeed, hospitals must implement proven
management strategies that include the ED as part of the entire organization, allowing the entire
facility to operate more effectively.
Robert Hitchcock, M.D., FACEP, is Vice President and Chief Medical Informatics Officer of T-System Inc., and a practicing emergency physician at Manatee Memorial Hospital and Lakewood Ranch Medical Center in Bradenton, Fla.
