11 Benchmarks That Should Matter to EPs

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Why should we care about benchmarks? They are a way to be proactive in evaluating and improving your practice before you get criticized, fired, or have your compensation reduced.

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Become a student of your ED’s stats and move from being a reactive to a proactive problem solver

Why should we care about benchmarks? They are a way to be proactive in evaluating and improving your practice before you get criticized, fired, or have your compensation reduced. They can help you move beyond reactive evaluation related to a complaint, a poor patient satisfaction score or a suit, when you might not focus on the best things for improvement. Here are some of the top benchmarks that should matter to emergency physicians.

1.門到醫生的時間
患者到達醫生或中級提供者的幾分鍾數是對患者的第一名令人擔憂,並且可能是優秀患者護理的最佳駕駛員。我們需要找出誰在最少的時間內生病。滿足這一期望,您將滿足大多數患者,管理和提供高質量的護理。“優秀”閾值小於30分鍾,最佳EDS約10分鍾。也就是說,普通ed ed很難在一個小時內獲得這個數字。


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2. Door-to-Room Time
在患者到來和被置於患者護理區域之間的分鍾數是您的前端流程的最佳指標。平均執行ED將是大約25分鍾,在5分鍾內的最佳EDS時鍾。該參數主要受患者與床單的比率影響。如果您有很多患者競爭少床,則低醫生到室的時間將難以實現。但是如果您發現盡可能遠,使用並行流程而不是串行處理,您仍然可以使其工作。您可以使用虛擬床在患者獲得簡要考試的情況下,患者返回控股區域。這允許給予遵循患者而不是阻止患者。您必須遠離大多數EDS仍在使用的傳統前端處理。請記住,患者隻記得看到醫生需要多長時間。事實上,他在候診室等了一個小時,房間裏隻有5分鍾不會改變他對等待的印象。 This is a valuable tool in speaking to administrations about changing staffing, facilities, and other bottlenecks that are out of the control of the doctors.

3. Admit Decision-to-Depart Time
Once the decision is made to admit, how long does it take to actually leave the ED? Given the state of EDs around the country, the current “excellent threshold” is 100 minutes. The average of all EDs is a little over 2 hours, but the average ED with a census of over 70 thousand patients is over four hours. In most EDs, in fact, more time is spent on this end of the equation than all of the “value added” time being seen and evaluated by the staff. The question is whether your floors are pulling the patients up or is the ED having to push the patients. This is a question of hospital culture and must be handled with the full cooperation of administration and nursing. And there are lots of ways to improve this number, from streamlining the nurse reporting system to boarding patients in the hallways of the floors to which they are going instead of the ED. This is always a political question that cannot be fixed by the ED leadership alone.

4. Left Without Being Seen (LWBS)
This number is tracked very closely by administration whether EPs like it or not. EPs often view the LWBS patients as those whose illnesses and injuries were not sufficient enough for them to feel they needed to wait, or worse, patients with such a short fuse that we would rather not have them in the ED anyway. Administrators see these patients as lost revenue and increased potential liability. So if you want to stay working at your hospital you must pay attention to this number. The “Excellent Threshold” is 1% or less with the best EDs being much lower. But the truth is that the average ED seeing more than 70 thousand patients has 3% or more of their patients leaving without being seen by a doctor. This number correlates very closely to door-to-room and door-to-doctor times.

5. Satisfaction Survey Percentile Ranking
This falls in the camp of “if it’s important to the administration it must be important to us” despite the flaws in selection bias, small sample sizes and recall bias. To make matters worse, we all know that patient satisfaction is compared on a percentile ranking rather than raw numbers. So if all the physicians or hospitals being compared score very closely, just a few points difference in raw score could push an EP or hospital from the top percentile to the lowest. Nevertheless, these are going to continue to be important to administrators, particularly with the new pay-for-performance initiatives that tie hospital revenues to patient satisfaction.


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Realize that some hospital administrators’ pay is tied to patient satisfaction. Further, in the future there will also be more public reporting and hospital-to-hospital comparison of patient satisfaction. So, like it or not, these stats have to be important to us. Ways to improve patient satisfaction are myriad and relate to waiting times, communication, and the perception of care. There are also technical ways to improve scores, however, such as using telephone surveys of larger numbers of patients to dilute the impact of a few vocal unhappy campers.

6.急救醫師的工作滿意度視角
問題是“你的工作有多滿意?”這是主觀的 - 必須是匿名來獲得一個很好的樣本 - 但它與其他主觀調查相比。高員工滿意度通常反映效率和員工關係。普通的ED醫生是“滿意”。雖然具有較高卷的EDS,但在其他基準上的較高等待和一般較低的分數是最高的報告的ED工作滿意度(按小邊值),這是諸如補償,靈活的調度和訪問顧問等因素。高等醫師滿意度與長期等待或性能不佳無關。

7.急診護士Perspective of Job Satisfaction
On average, emergency nurses are less satisfied with their jobs than emergency physicians and this is similarly true with higher volume EDs. This number correlates with nursing staff turnover rates, medical errors, and patient satisfaction.

8. EP Perspective of Nurse/Physician Relationship and Emergency Nurse Perspective of Doctor/Nurse Relationship
這些是兩個相關的調查。“優秀的門檻”是良好且優秀之間的平均分數。如果您的分數平均小於那個,或者單個分數得分低得多,則必須解決這些。有時,這與人員配置水平和/或勞動分工有關。如果領導層沒有意識到這些問題,直到它為時已晚,它將導致員工營業額,醫療錯誤,它會傷害患者滿意度。我們知道這意味著什麼。

9.PCI 90分鍾內
There are clearly better benchmarks of an ED’s clinical competence, but the current public awareness is that this number is related to quality care. We all know of the clinical benchmarks that are either irrelevant or even harmful to quality care. But this just emphasizes that EPs must t
ake charge of what clinical benchmarks are important.

10. Consultant Responsiveness
這是通過詢問EPS“您的專家隨叫隨到的麵板如何響應您的專家接通小組”來衡量,可能的響應為1 - 不響應,4 - 略響應,7-大多數響應,10-始終響應。由於大多數專家的回調性質,響應時間的實際數字很難捕獲。但是要處理感知是很重要的。平均ED分數略低於7,“大多數響應” - 普通社區醫院得分最低。雖然它可能不是原始分數,但在討論管理問題時,將自己的醫院對他人進行比較與他人的響應程度有助於。

11. Medical Staff Perspective of ED Performance
Whether it’s reality or perception, it is important to know how the medical staff views the ED. The “Excellent Threshold” is 9 out of 10. But the average 70k volume ED is only thought of as “good” by the medical staff. The average community hospital scores only slightly better on this survey. Scoring poorly on this survey can mean that your group is not likely to keep the contract. Scoring well can mean job security and a better place at the table when it comes to negotiating your group’s cut of the bundled payment pie.

Summary: The driving force of benchmarking must be improvement of performance. Benchmarks serve no purpose if they do not reflect the needs and perceptions of all the stakeholders. ED leadership must transition from reactive to proactive problem solving. A dedication to continuous performance improvement through ongoing benchmarked surveys that engage all the stakeholders recognizing and rewarding success will result in a culture of quality.

Mark Reiter,MD,MBA,是ED谘詢服務緊急卓越的聯合創始人和首席執行官。

11 Comments

  1. I would second the above comment — where can we find national benchmarks and medians for the indicators above?

  2. DARLENE NELSON

    開始從CMS改善拍這樣的指標ient care and satisfaction. They have been hijacked by cooperate healthcare to increase profit. A primary metric that results in rushing care and has increased bounce backs is the door to discharge metric or length of stay. In the ER nurses and providers rush under enormous pressure as the ninety minute clock from door to disposition begins to tick. Nurses and Physicians face counseling to job loss when they fail to have satisfactory “numbers.” This is a leading cause of job disatisfaction, burn out, ethical dilemmas and ultimately preventable medical error. Care should always be patient need focused and not satisfactory metric focused. Metrics have little to nothing to do with patient satisfaction and everything to do with cooperate greed.

  3. Hey Mark – I’m surprised I hadn’t seen this article until now. Thanks for doing it.

    I’d like to see more debate about the effects of each of these metrics on the individuals delivering care. Sure, we can make dashboards that put these metrics in front of workers so they remain aware of how they’re doing. But isn’t it piling on additional and unnecessary stress? Like Darlene Nelson implies above, it seems like we need a different solution.

    I suspect the ideal real-time metric captures the performance of the whole department as interdependent team members, rather than isolating the performance of any particular individual.

    我並不建議應該抑製其他數據。但我認為我們需要深思地了解個人性能指標如何激發,而不是抑製團隊成員。

    我對你的問題......
    If you could use ONLY ONE metric on a department performance dashboard, what would it be?

    我很樂意和你討論這個問題。很好,可以單獨造成這些措施的熱鬧討論。

  4. 這是偶然的。一個4個URI的家庭和膿毒症患者和有CHF的MI可能有一個AAA的MI被置於同一個“時間範圍”。

    The septic patient and the MI patient aren’t called for patient satisfaction because they’re admitted…… but the family of 4 is.

    他們很沮喪,因為他們不得不等待,醫生趕時間。

    Gee, I wonder why?

  5. Jane Cassel

    Hello,
    I currently am the Clinical Nursing Director of a Level 1 Trauma Center and Emergency department that is also an Academic Medical teaching center. Is there any data that I can review that measures and compares benchmarks for ED throughput with other academic medical centers? I appreciate your response.
    Thank you

    Jane

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