Bellevue Hospital Center - “Finding Effective Ways to Free Up Inpatient Bed Space”

In addition to the special populations it serves, Bellevue Hospital Center’s emergency department has seen an increase in uninsured patients and those with stress-related illnesses since the 2009 economic downturn, and a 25 percent increase in the last three years. Strategic process improvements have helped the hospital handle the influx and free up inpatient beds—its biggest challenge.

Arriving patients experience a quick 5-minute triage, and are designated as “fast-track” or “acute.” Fast-track patients are taken to a separate treatment area for patients being treated and released, which ensures these patients are seen as quickly as possible and prevents bottlenecks to the acute care area of the ED. Roughly 37 percent of adult patients who come into the ED are designated as fast-track or urgent care. Other patients are evaluated for possible admission.

During peak times, the hospital employs its emergency incident command system, using alerts to notify the entire hospital of specific action that needs to be taken to relieve pressure on the ED. An electronic bed request system informs admitting clerks of new admissions, and an electronic bed board allows for speedier identification of empty hospital beds. Timely discharge of patients is promoted throughout the hospital.

These strategies have resulted in reduced lengths-of-stay in the ED, from eight to six hours for admitted patients—within the top 25th percentile of the 2009 NAPH ED Survey. Only 2.5 percent of patients leave without being seen.

According to Marcy Pressman, Senior Associate Executive Director, Bellevue is focusing on improving throughput for patients who have long lengths of stay. “We’re redesigning the care teams, using more nurse practitioners for less urgent patients and targeting physician resources toward acute care,” she said. Eighty five percent of the hospital’s admissions originate in the ED.