Addressing Fluctuating Patient Volumes During COVID

Background

Charles Regional Medical Center, a community hospital in Maryland, experienced a dramatic drop in volume during the early phase of COVID, necessitating a reduction in physician and APP staffing. When volume returned, the acuity mix was much higher, and their previous patient flow model did not match up well to the new patient demand. Patient experience scores suffered, length of stay was exceedingly long, left without being seen rate rose, and ambulance diversion hours were rising.

Interventions

Partnering with Queue Management, a demand-to-capacity analysis was performed, looking at hourly arrivals of patients along with their ESI triage criteria. A 9.5% increase in ESI 1 and 2 patients (highest acuity levels) was found with a corresponding decrease in ESI 3, 4, and 5 patients. Based on this analysis, a new patient flow model was developed, with the appropriate levels of staffing for nurses, physicians, and APPs for each area of the emergency department.

Results

After implementation:

ED overall LOS was reduced by one hour
LWOTs dropped by 66%
EMS diversion hours went to zero
Patient satisfaction scores steadily rose by 50%

Conclusion

Reducing waiting times and long length of stay is about appropriately matching capacity to demand. Understanding patient demand requires assessing both hourly volume and acuity. Without knowing your demand, developing the correct patient flow model and accurately matching staff hours is impossible.

Queue Management is a healthcare consultancy specializing in demand-to-capacity matching and patient flow modeling for emergency departments. To learn more, go to queuemgmt.com.