The practice of emergency medicine is constantly changing as populations, demographics, and best practices evolve. Increasing patient volumes coupled with decreasing numbers of emergency departments have contributed to significant ED crowding across the United States. Further, innovative technologies and care delivery advancements have enabled emergency physicians to provide unprecedented care in the ED setting.
All of these changes require optimization of the systems and processes by which we deliver care to our patients. Regulatory bodies are focusing on metrics of patient safety, health care quality, and patient experience — and tying reimbursement to those metrics. Emergency physicians are uniquely qualified to design, implement, and lead our specialty through these exciting changes.
The new EMRA Administration & Operations Committee focuses on the science of monitoring, managing, and improving processes (administration) and on delivering high-quality, efficient services or products to consumers (operations). ED operations includes the systems and processes we use to care for patients every day, along with strategies for improving these systems. These concepts are becoming more and more important in medicine. It is incumbent upon the emergency physician to understand these ideas to lead improvements in care delivery processes and patient-oriented outcomes.
As an example, think about the complex processes involved in operating an airline. Customers buying tickets, arriving to airports, boarding planes, and traveling to their destinations. Pilots flying aircraft from destination to destination. Flight attendants seating customers and serving them in flight. Baggage handlers ensuring luggage arrives at the correct baggage claim station. Mechanics keeping the aircraft in peak working order. The list goes on and on. All this needs to happen in a coordinated and rapid fashion without mistakes. Furthermore, customers should enjoy the service they receive, and the airline should make a profit. These things take constant dedicated study and management.
Although comparing airline operations to health care is not perfect, one can see how this example relates to the processes required by an emergency department to provide care to patients. Emergency medicine consists of out-of-hospital providers, techs, nurses, patient care assistants, physicians from various specialties, ancillary services, physical emergency department space, and various floors and units throughout the hospital. It only makes sense that we should be monitoring, managing, and improving our processes like any other industry.
Operations usually focuses on broader issues as opposed to individualized treatment plans for specific diseases. Operations in emergency medicine includes concepts such as patient progression (flow), quality improvement, patient safety, and patient experience. Processes such as direct to bed, bedside registration, triage protocols, provider in triage models, clinical decision units, and fast-track area are all operations-based attempts at improving ED function.
Emergency physicians are constantly doing quality improvement projects to improve the care of our patients. Patient safety is a paramount concern for every provider and health care system. Just like every other service industry, our patients’ experiences matter, and we should work to make our patients as comfortable and satisfied as we can while providing the best possible care.
Does emergency medicine operations management or quality improvement interest you? Do you have an interest in medical direction and administration or want to learn more about them? Are you interested in patient safety or patient experience? If so, please consider joining the new EMRA Administration & Operations Committee, which held its first committee meeting at CORD Academic Assembly in San Antonio. We had a great time and developed a lot of exciting project ideas.
We have been working hard on updating the EMRA administration fellowship database, compiling a research database, developing collaborations with other EMRA and ACEP committees, and we hope to start a mentorship program in the near future. We are looking at ways to increase the baseline level of operations understanding of all emergency medicine residents through publications and other FOAMed sources.