Category Archives: Delia Caldwell

Was Your New ED Designed to Fit the Way You Work?

computer simulation modeling

October 19, 2015  |  Delia Caldwell

Maybe you have a new emergency department (ED) under construction, or work in a newly built ED. But what if it wasn’t designed in conjunction with your specific operational processes? Either way, you will be challenged to work within the confines of the new space and meet the increased expectations that accompany it. Just because… | Read More

What the Iphone Game “Diner Dash” Taught Me about Optimizing Emergency Department Throughput

February 19, 2015  |  Delia Caldwell

Like most people, within hours of purchasing my first Iphone, I discovered game apps. Since that time I have spent entirely too much time playing them. One game in particular, Diner Dash, has taught me some valuable lessons about optimizing emergency department throughput. The basic premise of Diner Dash is that Flo, the proprietress, acquires… | Read More

Three Ways ED Hallway Beds Make Your LOS Longer and Your Staff Less Productive

October 14, 2014  |  Delia Caldwell

I’m on a campaign to remove hallway beds from emergency departments across the country. Perhaps this seems like an unorthodox idea, but three factors convinced me that hallway beds do not belong in the ED. 1) Adding more capacity in the form of hallway beds typically increases LOS because it creates more places to “store”… | Read More

“We just moved in, it’s beautiful, but it doesn’t work!”

August 29, 2014  |  Delia Caldwell

After every conference presentation we give, at least one clinical department director will approach us and proclaim,  “We just moved in, it’s beautiful, but it doesn’t work!” Common signs that a new or newly renovated hospital department doesn’t function optimally: You may have long waiting queues Long process times (that should be short) Duplication of… | Read More

Four Ways Emergency Physicians Can Improve Patient Flow

August 27, 2014  |  Delia Caldwell

Emergency physicians can employ the following patient flow techniques to expand their capacity and evaluate more patients. USE OF SCRIBES Hospitals increasingly depend on physicians and nurses to capture data to help them meet reform requirements to earn incentive dollars and avoid financial penalties. Proper documentation to support the level of services provided is always… | Read More

Average Daily Census is a Myth

August 6, 2014  |  Delia Caldwell

The old joke about how even a broken clock is right two times a day has a lesson for hospitals — and in particular, one of the time-honored metrics they use. The average daily census (ADC) is derived by taking an average across all times of the day and night — numbers that often vary… | Read More

There Are No Outliers in Healthcare Benchmarking … Only Real People

July 15, 2014  |  Delia Caldwell, MBA

For emergency departments engaged in healthcare benchmarking, it might seem natural to focus on tracking median statistics for patient care — such as Time to Provider and Length of Stay for Discharged and Admitted patients. But relying solely on median numbers, in my experience, tells only part of the story — and a slightly skewed… | Read More

Need To See More Outpatients and Reduce Wait Times but Can’t Build More Space?

June 19, 2014  |  Delia Caldwell

Do these sound familiar? Patients must wait more than three weeks for an appointment for a non-urgent visit such as a yearly physical evaluation. There are no available appointments within 24 hours. If patients are ill they are told to go to the ED. Once patients arrive at the outpatient center, their stays are longer… | Read More

A Balanced Approach to CMS Core Measures for Healthcare Providers

June 11, 2014  |  Delia Caldwell

In 2013, CMS made reporting of certain emergency department statistics mandatory. In 2014 those reportable statistics were broadened. These ED core measures are reported as part of the Hospital Compare initiative that allows healthcare consumers to compare services and metrics among hospitals. Currently, CMS takes a small patient sample from EDs for reporting; hospitals do… | Read More

Rethinking Registration: Changing the Check-in Process for Emergency Departments

June 4, 2014  |  Delia Caldwell

As EDs look for ways to improve efficiency, one possibility is to consider is the registration process. It’s an essential step in getting the patient into the workflow of the ED, yet in practice it can often become a bottleneck. There are a variety of approaches that EDs are following to rethink registration — ranging… | Read More

How Protocol-Driven Medicine Improves Emergency Department Operations

June 3, 2014  |  Delia Caldwell

Today, more and more hospitals are adopting protocol-driven (or template-driven) approaches to emergency department procedure. When an ED implements protocols effectively, these methods can dramatically improve emergency department operations and deliver care more quickly. Yet protocol-driven medicine is not a universal practice. Why are protocols important? How does protocol-driven medicine reduce wait times? And how… | Read More

More Physical Capacity Doesn’t Necessarily Improve ALOS

May 28, 2014  |  Delia Caldwell

As patient volumes have increased over the past 15 to 20 years, many institutions have chosen to expand their footprint, number of treatment areas, or both. Common signs that a department doesn’t optimize space appropriately: You may have long waiting queues Long process times (that should be short) Duplication of tasks Wrong staff completing tasks… | Read More

Triage Today: More of a Process than a Place

May 13, 2014  |  Delia Caldwell

When many people hear the term “triage,” they think of a place — a room or perhaps even a chair in front of an Emergency Department reception desk. In this case, triage is a noun, a physical space where a patient goes for initial evaluation and vital assessment before moving on to see a nurse… | Read More

Our Take: Top of License Practice and Highest and Best Use of Clinical Staff

May 12, 2014  |  Delia Caldwell

Recently a lot of articles and educational sessions have focused on using staff to their highest and best use, but any staff planning needs to incorporate flexibility. Ideally, there is always the right person available to complete a necessary task when that person is needed, and any capacity and process analysis can determine the ideal… | Read More

Mid-Level Providers in the Emergency Department

May 8, 2014  |  Delia Caldwell

There has long been a tradition in emergency departments — some might even call it a bias — of relying solely on physicians and nurses as the providers of medical care. Times are changing, however, and the use of mid-level providers, particularly Physician Assistants (PAs) and Nurse Practitioners (NPs), is allowing many EDs to bring… | Read More