‘Average’ ED performance linked to low care quality: Report

Many U.S. emergency departments operate “good enough,” and this level of performance is harming patients, margins and morale, according to a Jan. 29 report from Kaufman Hall. 

“Average ED performance is not neutral. It is a decision to tolerate risk, leakage, patient dissatisfaction and variable quality of care,” the report said. “It exposes patients to avoidable harm, quietly erodes margin and accelerates workforce fatigue, while signaling to patients that mediocrity is an acceptable standard.”

The typical ED has a median door-to-provider time between 25 and 45 minutes, as well as a left-without-being-seen rate of 3% to 5%. These EDs usually operate with reactive staffing models, thus creating predictable bottlenecks in patient flow, according to the report. 

“Many EDs staff to historical averages in daily volume, arrival patterns and acuity,” the report said. “But emergency care is defined by variability. Arrival patterns change by hour, day and season. Fluctuations can quickly overwhelm resources.”

Additionally, “staffing to averages guarantees average outcomes” while fueling burnout for an already strained workforce, the report said.  

Kaufman Hall recommends EDs staff to demand not based on historical averages but on patient arrival data and predictable surges. The report also underlines the importance of ensuring physicians, nurses and support staff operate in tiers that are flexible to demand shifts. 

Read the report here. 

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