Optimizing for higher patient volumes in the ER while reducing wait times, controlling costs and improving the quality of care


The emergency room is often described as a hospital’s front door. A significant portion of any hospital’s daily unscheduled admissions flow through this portal. Without the ER, and a loyal community of referring physicians, no hospital can survive.

Many pundits predicted that ER volumes would fall under the auspices of the Affordable Care Act (ACA). The thinking was that as more people had access to health insurance and therefore a primary care doctor, fewer folks would look to the ER as their primary care provider. However, old habits are hard to break and many people can’t find a primary care doctor or discover the doctor isn’t available when they need to be seen. Hence, ER volumes continue to rise.

In order to deal with this, hospitals may find themselves between a rock and a hard place. In order to care for an increasing volume of patients, the hospital may need to expand facilities and staff, but that’s really expensive. It also doesn’t pencil out when reimbursement from both public and private insurers is going anywhere but up. So, if expanding the size of your emergency room facilities and staff isn’t on the table, what can you do? Well, clearly the best and most affordable option is to figure out how to move more patients through the facility you already have by improving efficiency and productivity.

imageBack in 2009, long before the ACA, I told you about the work of Dr. Christopher DeFlitch and his colleagues at the Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania. At the time, Dr. DeFlitch told me, “Rather than simply building more of the same or expanding waiting rooms, we used scientific principles to study our processes and build inherent change in the delivery system. This model lets us provide patients the right care, at the right time, in the right location.”

The team at Hershey utilized information technology to optimize their limited resources and change how they did things. DeFlitch and his colleagues began working with the information technology and industrial engineering staff at Penn State-University Park to find ways to do more with less. Through a process called health care engineering, which applies flow modeling, queuing theory and advanced information technology to health care processes, the Medical Center created a unique model that improved access to, and the quality of, emergency care at less cost.

Dr. DeFlitch says since then the medical center has achieved breakthrough improvements in emergency department key performance indicators. These improvements have been both dramatic and sustained. They include:

  • Patients leaving without being seen (LWBS) decreased from 5.7% to 0.6% (87% improvement), maintained over years
  • Mean patient wait time has gone from 65 min to 12 min (83% improvement)
  • Median time door to doctor from 51.5 min to 19.3 min (63% improvement)
  • Median time door to bed from 224 min to 19.3 min (91% improvement)
  • Patient Satisfaction up 400%

That last point is particularly important since patient satisfaction is among the indicators being used to determine care quality and therefore future reimbursement by payors under ACA and accountable care guidelines.

imageAccording to Dr. DeFlitch, his organization realized significant revenue enhancement through the use of his team’s health care engineering optimization software and processes. New operational gross revenue improved by $5 million based only on the ability to care for those who previously left without being seen. The medical center also saved an estimated $13 million in capital expenses by needing only minimal space expansion to handle higher patient volumes compared to what had been anticipated before health care engineering and process improvement steps were adopted. In addition to the improvements realized at Penn State Medical Center, the methodology and technology have since been applied at The Chester County Hospital in Chester, Pennsylvania, with similar results.

Based on the experienced at Hershey Medical Center, Dr. DeFlitch and his colleagues have now formed a company to help other hospitals improve clinical work flow and reduce patient wait times. The company uses software that is architected to support standardized process models interfaced with aggregated industry data and browser-based interview tools. The software runs on current versions of Microsoft Windows without special hardware or software requirements. All reports are generated as native Microsoft Office documents in Excel or Word. The company says future migration to a cloud services model is anticipated. For more information, you may contact Dr. DeFlitch at cdeflitch@comcast.net.

The healthcare industry is going trough a dramatic transformation. Although demand for services will continue to rise, not all hospitals and clinics will thrive. Those that do, will need to become savvy in the use of care re-engineering processes and clinical analytics software to maximize patient flow-through, better the patient experience, and continuously improve care quality.

Bill Crounse, MD                      Senior Director, Worldwide Health                   Microsoft 


Comments (1)

  1. Jared Steele says:

    Thank you for the write-up, these conversations have been on my mind recently.

Skip to main content