On the Edge of Chaos: ED Operations

The ED has been called an "operation existing on the edge of chaos." Join EMRA*Caster Kate Joyce (@sceneisnotsafe) and Henry Ford Hospital ED Medical Director and Vice Chair of Operations Dr. Seth Krupp as they walk that chaotic edge. We'll be talking about how EDs keep things moving and what residents interested in operations can do to get involved.

SHOW NOTES
In 1999, Drs. Mark Smith and Craig Feied called the emergency department an "operation existing on the edge of chaos." More than 20 years later, we are still walking that edge.

The nature of emergency medicine is, at its core, reactive. Emergencies are not scheduled, so emergency departments must be ready to handle anything, with no notice. This makes the role of the operations manager absolutely critical.

What does it take to thrive in ED operations? How do you know if it’s right for you? Seth Krupp, MD, ED Medical Director and Vice Chair of Operations at Henry Ford Hospital Emergency Department in Michigan, shares some insight with EMRA*Cast host Kate Joyce, MD, MPH. 

Key Take-Home Points

• COVID-19 revealed new challenges and opportunities related to operations and throughput in the emergency department.
• Market forces, health policy, and social determinants of health all combine to drive patients to the safety net - the ED - rather than scheduled care; the impact on operations is felt system-wide, but it begins in the emergency department.
• Do not lose sight of the patient perspective in favor of focusing on numbers. The patient pathway includes an incredible number of obstacles that make it difficult to actually get in front of a doctor.

Is ED Operations Right for You?

• Find a mentor who allows you to shadow him/her on administrative tasks.
• Identify an initiative that could improve operations in your ED, and then fully own the process of seeing that idea through to implementation.
• Sit in on committee meetings at your hospital; serve on committees if given the opportunity.
• Pursue a fellowship in administration/operations.

Dr. Krupp’s #1 Recommended Resource

• The Definitive Guide to Emergency Department Operational Improvement. Jody Crane & Chuck Noon.

Further Reading & Listening

• ACEP Information Paper. Emergency Department Operations Management. 2004.
• Cohen BA, Wessling EG, Serina PT, et al. Emergency department operations in a large health system during COVID-19. Am J Emerg Med. 2021;41, 241.
• Mohr NM, Wessman BT, Bassin B, et al. Boarding of critically ill patients in the emergency department. Crit Care Med. 2020;48(8):1180-1187.
• Smith M, Feied C. The emergency department as a complex system. George Washington University School of Medicine and Health Sciences.
• Wiler JL, Gentle C, Halfpenn JM, et al. Optimizing emergency department front-end operations. Ann Emerg Med. 2010;55(2):142-160.
• Muradian M, Novak DA, Stark N. What you need to know about EM Administration Fellowships. EM Resident. 2022;49(1):39.
• AAEM Podcast series on Emergency Medicine Operations Management.

Interested in Getting Involved?

• EMRA Administration & Operations Committee
• EMRA Fellowship Guide. Chapter 3, Administration/ED Operations/Patient Safety & Quality Improvement Fellowships