4 Strategies for Managing Busy Emergency Departments

On the Becker’s Healthcare list of the busiest U.S. hospital emergency departments is No. 11-ranked WellStar Kennestone Regional Medical Center in Marietta, Ga., which partners with ApolloMD to provide care in its 166-bed ED.

Leading that busy department is Medical Director Désirée La Charité, MD, FACEP, who credits communication, collaboration, innovation, creativity, teamwork, and the ability to pivot quickly to ensuring:

• patients and their families receive speedy, expert, high-quality care
• the ED team and specialists who provide care return to work each day energized, engaged, and prepared for whomever and whatever comes through the doors

She offers insights on managing a suburban Atlanta ED that treated 132,984 patients in 2022, highlighting the importance of effective emergency department management strategies to handle such high volumes efficiently.

The Unique Challenges of Emergency Department Leadership

“It takes a certain kind of person to be wired for the emergency department,” says Dr. La Charité, who joined Georgia-based ApolloMD in 2009 after completing a medical residency at Carolinas Medical Center in Charlotte and then helping create the University of Wisconsin’s emergency medicine residency program.

“It’s definitely organized chaos at times. You’re constantly making quick decisions on limited information, and you have to constantly re-prioritize your to-do list. You’re with the sickest patient in the ED until a sicker patient arrives.”

Some key management and organizational tenets are always in play, she says. Staying updated on current best practices is critical for managing busy emergency departments effectively. So is practicing at the top of one’s capabilities in line with medical studies and research.

“Success also relies on communication, collaboration, and innovation,” she says. “The ED is always a team effort. There’s no ‘I’ in emergency medicine. It takes a lot of discussion planning and collaboration to get everybody on the same page.”

Dr. La Charité shares some time-tested strategies and management tips for successful operation of a busy ED.

Organize the Chaos

Start by looking for consistent patterns and then organize your health care teams accordingly.

“If we know that Monday and Tuesday nights are our busiest nights, for example, we staff those days differently than we might staff a Sunday morning,” she explains. This approach is crucial for managing high-volume EDs and ensuring optimal patient flow.

Observe what happens, seek input from all team members on all aspects of ED operations, and explore solutions that support the department’s goals: speedy, expert care that is provided on what is often the worst day of each patient’s life — and in ways that leverage the skills, input, experience and needs of the ED team members.

Look around at other aspects of the ED and decide where improvements, changes, tweaks, or overhauls are needed or begging for solutions. Identifying areas for improvement is a key strategy for effective emergency department management.

Communicate … and Then Overcommunicate

Stay equally connected with frontline team members and off-site administrators, a concept that Dr. La Charité says was highlighted during the challenges faced by emergency department employees during the COVID-19 crisis.

“COVID-19 really exposed a lot of the cracks that existed in the ED around resources, staffing, supplies and other challenges,” she says. “One of the frustrations that ED staffs felt during the pandemic was that they didn’t have the information they needed. What was happening with their patients? What was happening with staffing and supplies? Where are we going from here?

“The way I helped our department through that was by overcommunicating,” she says. “I overcommunicated whatever information I could get to the group so that they understood the what, where, why, and how of what was happening. They knew that I, as a director, was doing whatever I could to improve situations. It takes lots of collaboration to connect hospital administrators and top-level physicians with the boots on the ground in the ED.”

She credits ongoing communication, in fact, with solid hospital metrics and the professional satisfaction of her colleagues and direct reports.

“It’s important to communicate when things are going well and when things are not going well,” she points out. “I meet regularly with my team members, and I reach out to other departments and divisions for their input. When I look around in the ED and see the physicians and the nurses and the team members smiling, that’s a good barometer. If I can see that they’re providing good care, it’s because they know they have the staff, resources, and procedures that help them do their jobs.”

Adapt and Innovate: Key to Success in Busy EDs

When things are not working as promised or as needed, brainstorm, innovate, and change. This flexibility is essential for managing busy emergency departments effectively. At larger EDs patient flow can be sluggish at times.

The Kennestone team improved timely care by creating a rapid-care unit. They remodeled the ED space so that patients who did not need to be on a gurney or hooked to a monitor in a treatment room could be redirected to smaller treatment rooms with recliners.

Creating these new spaces and protocols for quick treatment and release “really helped decompress the patient flow in our ED area. We remade the space for our sickest patients while keeping the revolving door moving for those who could be treated in smaller spaces and sent home quickly.”

Continue to view your ED with new eyes and questions. What’s working great that can be replicated elsewhere? What needs a few tweaks to work even better or flow more smoothly? What needs to be revamped so that patients receive better, expedited care? Regularly assessing and refining processes is a hallmark of successful emergency department management.

Sharing Ideas for Better Emergency Department Management

“You always have to be a few steps ahead in emergency medicine, and we all like to share ideas around innovation and improvement,” says Dr. La Charité.

She routinely checks in with other ApolloMD medical directors to identify challenges, explore solutions, share positive results and ideas, and take advantage of innovation.

“We always need to pivot,” she says. “Sharing ideas and planning ahead help us figure out how to pivot. We follow specific metrics on the quality of care we provide, and it’s very satisfying, for example, when we know we’re meeting our goals for treating stroke patients in a timely manner.”

Sharing what works in one ApolloMD location can often improve care in other ApolloMD EDs throughout the U.S. This collaborative approach is vital for managing high-volume emergency departments and ensuring consistent, high-quality care.

“All of us in the ED are here because we truly want to take care of people in their time of highest need,” says Dr. La Charité. “What’s most rewarding is when we can come together as a team and really take excellent care of each patient, knowing we can walk away that we had the skill, resources and ability to make a difference.”

For more insights on managing busy emergency departments or to connect with our team, contact us!