Blog Posts


The Hospital Executive's Guide to Emergency Department Management

Posted on Thu, Feb 12, 2015
The Hospital Executive's Guide to Emergency Department Management

By Kirk Jensen, MD, MBA, FACEP; Daniel G. Kirkpatrick, MHA, FACHE
Second Edition HcPro 2014

“The Hospital Executives Guide to Emergency Department Management” has its roots in my thesis for my Executive MBA program and my interest in operations management and its application to healthcare. I believe that emergency department physicians, nurses and other team members deserve an Emergency Department that works not just for their patients but for the healthcare team as well.

Working with my colleague, Dan Kirkpatrick, and the editors at HcPro we built out an approach that would allow busy healthcare executives and managers to get an overall summary and appreciation of all the facets that go into creating a highly efficient and effective emergency department. To provide top-notch care to the community and maintain a competitive edge, healthcare executives must implement processes that deliver quality, safety, and service. In the second edition of “The Hospital Executives Guide to Emergency Department Management” we built on the key elements of operational excellence, refining the tactics for dealing with increased patient flow, strategies for handling the needs of special populations, and creating models for compensation and physician employment. The January roll-out of the Affordable Care Act has and will impact all ED’s for the near future. We offer strategies and solutions to help meet and effectively deal with the challenges of healthcare reform. This second edition is intended to update fundamental approaches to managing an emergency department while also building in necessary approaches allowing nimble changes in both strategy and tactics as healthcare systems navigate this new era.

Topics covered in the book include:

  • Design for operational excellence
  • Leadership
  • The ACA and the impact of healthcare reform
  • The impact of specialized groups and populations on the ED
  • Fielding your best team
  • Improving patient flow
  • Ensuring patient satisfaction
  • Implementing a plan for improvement
  • Culture and change management
  • Patient safety and risk reduction
  • The role and necessity of the Dashboard
  • Physician compensation
  • Billing, coding, and collection
  • The “business case”
  • Recruiting and credentialing

While we wrote the book originally to address the fundamentals of managing the emergency department, some of the recent changes have resulted in new alignments between emergency physician groups and hospitals (or healthcare systems) and different alignments between the healthcare system and payers. We are moving into a new era of both shared risk and increased focus on outcomes. Change requires reconsideration of strategic and tactical initiatives in managing the emergency department. We have preserved the majority of the content in this second edition because it is conceptually sound and addresses fundamentals which are relevant to emergency department management. The core issues of patient satisfaction, patient safety, risk reduction, process improvement, and employee recruitment, retention, and satisfaction should be the basis from which strategies are formulated.

Emergency departments are complex operational micro-systems. Our intentions with the second edition remain constant: to define the key operational tools and techniques that have the power to turn every emergency department into a state-of-the-art practice through operational excellence and to improve how emergency medicine is practiced in this environment of reform. Our objective was to update the key resources for emergency department management and hospital executives whose goals are to remain financially healthy while implementing new models of patient flow, patient safety, reimbursement, compensation, and physician employment in this new era for healthcare. Our purpose revolves around improving Emergency Department performance, quality of care, and the bottom line.

Kirk B. Jensen, MD, MBA, FACEP
Executive Vice President, EmCare
Chief Medical Officer, BestPractices
IHI Faculty Member



Get to Know our December Clinician of the Month, Cynthia Bratcher!

Posted on Tue, Dec 09, 2014
Get to Know our December Clinician of the Month, Cynthia Bratcher!

Cynthia M. Bratcher, MSN, APRN, FNP-C, CEN has been working as an emergency medicine professional for 25 years. Her commitment to care extends beyond the healthcare facility — it’s her passion. She teaches ACLS, PALS, and TNCC and her special interest in trauma led her to author two chapters of the Trauma Nurse Core Curriculum provider manual, 7th edition.

Not only does she share her experience and expertise in print and in the workplace, but she also contributes to EmCare’s blog, where she shares her unique insight on the most pressing issues she sees in the emergency department.

Read below to find out what spending 25 years in healthcare has taught Cynthia and what one new process she believes will be the future of healthcare.

The one piece of healthcare advice I wish everyone would follow is: to take steps to decrease modifiable risk factors that will improve the quality of life. Many of our most lethal diseases have modifiable risk factors. Modifiable risk factors for hypertension, diabetes, and heart disease are obesity and smoking, but obesity rates are rising and Americans continue to smoke at alarming rates. The hypertension that results in a stroke, the diabetes that results in kidney failure and the heart disease that causes a fatal myocardial infarction could be eliminated in so many patients’ lives by maintaining a healthy weight and not smoking. Patient engagement is the key factor in health promotion and disease prevention, and only by having patients partner in their health and decreasing modifiable risk factors can patient outcomes and quality of life improve. 

Sometimes it’s the patients that teach the care giver. One lesson a patient has taught me was: that they expect me to have clinical skill but at the most critical moments of their lives they will remember the small acts of comfort and kindness. I had just placed a cool cloth on the head of a patient who was having a myocardial infarction when he went into a life threatening rhythm and arrested. His son thanked me later because his Dad told him how much I did for him, and I informed his son that there was a team of nurses that were responsible for the successful resuscitation. He told me that the one thing that stood out in his father’s memory was the cool cloth, and he did not remember the other actions of the team. Cool cloths, warm blankets, and an extra pillow all seem like small things to those of us who are not suffering, but to the patient these actions are the care in healthcare.  We are health care professionals and are expected to be clinically astute, but actions that alleviate discomfort are very meaningful. 

RELATED ARTICLE: What’s in a Name? Three Reasons to Stop Calling Us Mid-Level Providers and What to Call Us Instead

What are the most promising tools, technologies, processes that you think will drive the future of healthcare? Electronic medical records are changing how we deliver care to our patients. The ability to have  a patient’s information from all medical providers through electronic medical records, utilizing the information to decrease the need for repetitive tests, and having previous health information can be essential in formulating a plan of care that more rapidly results in healing for the patient.  As these programs are enhanced and integrated, the efficiency of the healthcare team will improve and allow us to provide care to more patients.   

I hope my patients remember me as knowledgeable and compassionate. Many patients seeking care in the emergency setting have nowhere else to seek care, and treating non-urgent illnesses in the emergency department creates a challenge when the demand for care is increasing but our space is not. My role as an advanced practice provider is to diagnose and treat their condition, but treating them with respect and kindness is crucial with how the patients view me personally, the healthcare team, and the facility.


Dallas, TX | FT Nurse Practitioner
Hillsborough, FL | ED Medical Director
Lititz, PA | Nurse Practitioner
Olla, LA | Emergency Medicine Physician
Loxahatchee, FL | Pediatrician


Whitepaper: Optimizing Patient Flow in the E.D.

Posted on Wed, Nov 26, 2014
Whitepaper: Optimizing Patient Flow in the E.D.

It’s said that the larger the ED, the more time a patient will spend there. Unfortunately, patients do not perceive that as a good thing. You may have a great ED, have great people, give great treatment; but the fact of the matter is, the longer the stay in the ER, the worse the patient’s satisfaction scores. 

So, how do you get a handle on flow? 

Read this whitepaper to find out.



How one Hospital Shaved Off 88 Minutes from ALOS

Posted on Thu, Nov 06, 2014

With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.).  Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.



Search Top Emergency Medicine Jobs at LewisGale!



Clinical Hot Topics: ED 4.0

Posted on Wed, Nov 05, 2014
Clinical Hot Topics: ED 4.0

Hosted by Al Sacchetti, MD, FACEP as moderator, Don’t Blink or You Will Miss It - Clinical Hot Topics can feel much like the “speed dating” of training presentations. The 12 hyper-paced presentations covered a wealth of information for the 2014 EmCare Leadership Conference attendees.  Each week, we’ll publish highlights from select clinical hot topics presented at the conference.

ED 4.0
by William Jaquis, M.D.

Only about 50 years ago, an emergency room was any room where care was being provided for an urgent or acute condition. The “room” is now a “department” often serving more than 80,000 patients a year. The emergency department (ED) functions as the “hub of the enterprise” with many “spheres of influence” and accountability. The diagram shown here illustrates some of the many roles the ED plays. It has become a focal point for coordinating care, collaborating, planning and above all improving outcomes.

Successful ED leaders will master the art of managing the scope of this crucial department while balancing growing demands and decreasing revenues.

Read the whitepaper below to learn how a shift in processes, leadership and culture to an integrated solution can put your hospital on track to achieve improved clinical outcomes, metrics and patient experiences, each of which can have a potentially dramatic financial impact.


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