Healthcare Strategy Lessons from the UK
May 6, 2014 | Jon Huddy
As emergency departments continue to adapt to changing political and economic landscapes in the US, it can be instructive to look to strategies employed elsewhere for lessons. Hospitals in the UK offer examples of both adaptive tactics for more efficient emergency departments — and potential pitfalls.
How do some prevailing approaches to emergency department design and operations differ in the US and UK? What are the most important consequences of those differences for patients and departments – and what lessons can we learn?
Adaptation in the UK
As a service of the National Health Service, the UK’s Accident and Emergency (or A&E) departments tend to experience tremendous volume. What’s more, they often have to manage this volume in highly constrained spaces, operating with older facilities and a half to a quarter of the rooms that might serve similar numbers in a typical US emergency department.
This means – A&Es have learned to be adaptive, using every bit of space in their departments as efficiently as possible. Patients only occupy an exam space for as long as it takes to actually see a clinician, rapidly moving through the appropriate rooms. Patients don’t wait or remain in a given exam room for extended periods, creating the bottlenecks that you might encounter in many US hospitals — instead, nurses move patients in and out of evaluation and treatment spaces as required. Since many UK facilities gather a wide range of specialists under one roof, nurses are able to take a patient with, say, a broken finger and send them down the hall to the appropriate provider — and out of the A&E.
For hospitals with highly limited resources, this is simply a matter of necessity, and it allows A&E departments to function as well-oiled machines, processing tremendous numbers of patients in a relatively small physical space.
US emergency departments adapting to rising volume are beginning to take a similar approach to non-urgent patients, moving them in and out of exam space – rather than keeping them in one place for an extended period – in order to process more patients. This “supertrack” strategy attempts to address the major problem of a bulk of non-urgent patients slowing ED operations. Going forward, placing specialists and general physicians near emergency departments may also help reduce volume by mitigating the number of non-urgent patients in the ED.
Yet there are problems with the UK approach. It’s staff-intensive, and while it enables small spaces to handle great volume, wait times can still be quite long. Many departments fail to meet the UK requirement that wait times not exceed four hours
These waits are sometimes exacerbated by what we call “registration.” In the UK – as in many US hospitals – administrative officials collect patient credentials up-front. A process in which patients see registration officials first creates a potential point of failure right at the start, sometimes bottlenecking patients at the first step to care and extending the time to evaluation and treatment. By having patients see a nurse as soon as they enter the emergency department, before registration, clinicians may more efficiently evaluate each patient’s condition and priority.
Yet UK hospitals’ use of A&E space provides a model of efficiency. In the short term, instead of building new space to handle new volume, US hospitals can find more creative ways to utilize space. One way to do this will be preventing non-urgent patients from slowing ED processes. Keeping them in exam rooms only as long as absolutely necessary, as in the UK, can make for a more efficient department. By moving patients as necessary to facilitate swifter evaluation and treatment, as well as reprioritizing registration processes, departments may enable departments to provide care for more patients more quickly.