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All hospital emergency departments (EDs) are challenged in their quest to elevate satisfaction levels, reduce wait times and guard against patients leaving prior to a medical screening examination (LPMSE). With fewer resources than their metropolitan counterparts, rural facilities-particularly those not affiliated with a large health system-often find themselves trapped, unable to enact the care quality and revenue improvements that are necessary to succeed in a rapidly evolving healthcare system.
For one, finding and retaining quality physicians, nurses, administrators and ancillary staff in these regions, particularly those who are adept in working with a wide variety of patients and acuity levels, can prove exceptionally difficult. Rural facilities also traditionally lack the resources for IT infrastructure upgrades, electronic medical record (EMR) deployments and other capital improvements. However, emerging CMS and private insurer initiatives to elevate healthcare quality through financial penalties and incentives have created an operational and technical renaissance of sorts among small-town EDs.
 Explore Advances in Processes, Technologies
Rural hospital EDs are not overlooked; there are many expert resources at their disposal that can help diffuse the many challenges these facilities face. For instance, some EDs are looking to third-party clinical staffing and management placement firms to help ease personnel challenges, both clinical and administrative. Many offer healthcare professionals that are not only highly experienced in medical best practices, but who also are well versed in process assessments and operational improvement tactics that have proven effective in a variety of ED settings.
Technology developers are also helping to move rural hospitals forward by improving patient throughput, clinical documentation and quality reporting activities. Like other healthcare facilities, rural EDs have relied heavily on paper charts throughout the years, resting on the fact that, while time-consuming, manually recording care activities was a relatively straightforward process. More and more are getting on the IT bandwagon, driven by financial incentives such as the federal government's Health Information Technology for Economic and Clinical Health Act (HITECH), which will dedicate funds to help facilities deploy an ED information system (IS).
High Performance Has Clinical, Financial Benefits
Automated solutions that mimic paper-based templates are now available to ED clinicians, ensuring they have a leading-edge tool to assist in patient care that fits within their traditional workflows. Rural hospital EDs also are relying on the analytical capabilities of an EDIS to help improve key performance metrics, including patient and staff satisfaction, throughput and quality care. Advanced systems, such as the CMR Emergency Department Information System track all patient encounters, documenting activities such as the time an individual arrived in the ED, when they were first visited by a nurse or physician, when the orders were placed and results returned, and the time the visit concluded with either an admission into the hospital or a discharge.
One rural ED utilized these results as a baseline for improving the patient experience by helping staff become more efficient. Applying "kaizen" principles that emphasize standardized activities, ED staff instituted process improvements, including a revamp of the scheduling system that allotted shifts more fairly and matched peak hours to staffing levels with greater accuracy, which led to more efficient throughput and lower wait times for ED visitors.
Organizations are also leveraging these EDIS technologies that provide facility-level and procedure-charge coding features, adding accuracy to billing activities to maximize payer reimbursements. When combined with scoring models that help clinicians attach the appropriate level of acuity to patient record, EDs are able to produce charges that are more accurate and defensible-a significant revenue driver that paper records or even enterprise-level EMRs typically can't provide.
In addition to technology improvements, many EDs have taken further steps to assess their clinical procedures. While some will find their results are in line with top performers, others are realizing that nurses and physicians can improve quality by replacing the broad clinical protocols they have long followed with targeted care plans, including new, standardized treatment protocols based on national best practices.
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