Based on the premise that there is a dearth of information available to assist ED physician and nurse managers in optimizing the performance of their emergency departments and virtually no normative data by which to compare departments, the EDDI was established to provide hospitals with a mechanism to easily obtain an unprecedented amount of detailed comparative staffing, throughput and clinical data.
The goal of the project is to provide similar hospitals with regard to volume, acuity and staffing comparative performance data and, in the process, to anonymously identify the exemplars and disseminate their operational characteristics to participating similar hospitals.
The information will be gathered is through the completion of a baseline survey that details the characteristics of individual emergency departments, a monthly survey looking at patient volumes and staffing, and by the monthly data stripping of two specified days worth of charts of all key times, drugs, tests, dispositions, diagnoses, procedures, hospital APC codes and RVUs.
Fourteen hospitals – representing a variety of community, inner city and academic Eds – served as “testers” of this data gathering process. Charts of all types (scanned, dictated, electronic, paper) were sent to ACEP’s chart abstraction vendor, MedData, Inc. in Seattle. To maintain anonymity among the participating emergency departments a strict confidentiality process has been established.
One of the unique aspects of the EDDI project will be its combining of very specific staffing data to ED productivity and throughput times. Each month participating hospitals will provide the EDDI with total staffing hours by category – nurses, LVNs, techs, clerks, registration staff, physicians, PAs and NPs. This data will be linked with throughput data to assess staffing efficiency, a metric that is currently unavailable yet crucial to optimizing ED operations.
To guide the EDDI, an advisory board representing all stakeholders has been established. The board consists of six emergency physicians, including the chair, three nurses nominated by the Emergency Nurses Association, including the current president and a recent past president, and three hospital CEOs. The purpose of the EDDI Advisory Board is to see that the interests of all involved parties are represented in the collection, analysis and dissemination of the information.
The cost of becoming an EDDI participant is less than many hospitals are currently paying for patients satisfaction surveys alone. Specifically, the cost to participate in the EDDI project is $600 a month and $4 a chart (for the two days worth of charts that are to be data stripped). To put this into perspective, for a 40,000 ED the EDDI charge is $17,724 a year ($1477 a month – the collected revenue from approximately three to five discharged patients in most EDs).
To get the project underway, ACEP is seeking an initial 50 hospitals to participate. Once 50 hospitals are on board, data collection and dissemination will begin. Ultimately it is hoped that the number of participants will grow dramatically, making the database more robust and more broadly available. Only participating hospitals will be able to access the data and comparisons to similar hospitals.
What can one do to get the ball rolling at your hospital? First, you can read up on the project at ACEP’s web site, www.acep.org. If you, the ED director, decide that you want your facility to participate, ACEP asks that you gain the support and endorsement of your nurse managers. Then both should approach the hospital administration and encourage them to embrace the endeavor.
Hospital administrators are asked to sign a nonbinding letter of intent (also on the website) indicating their understanding of the costs, what the hospital will receive in return and what the hospital needs to provide the EDDI. Once the initial 50 hospitals are on board, data capture and dissemination will begin. Additional hospitals will then be invited to participate.
Only with detailed comparative data will ED leaders be able to drive the operational success of their departments. And, for the first time, now there is a vehicle to achieve what heretofore was otherwise unavailable — the detailed, comprehensive assessment of ED operations in order to achieve excellence. In the setting of the unparalleled challenges that the nation’s EDs are currently facing it is time to MEASURE, COMPARE and EXCEL — the motto of the EDDI.
For additional information, contact Marilyn Bromley, Director of the Emergency Medicine Practice Department at ACEP in Dallas at 800-798-1822.