The Introduction of Flow Facilitators: A Targeted Wellness Initiative in the Emergency Department

Background

Given that the 2020s have seen record levels of physician burnout, there is a pressing need to develop solutions to combat this trend.

Objectives

In this study we aimed to assess the efficacy of flow facilitators as an intervention to improve physician well-being in the emergency department (ED). A novel position in the ED was established and its impact on physician well-being assessed.

Methods

Emergency physicians at a large academic hospital were surveyed anonymously and met to discuss the factors affecting well-being and job satisfaction. Based on this meeting and survey results, the hospital system hired three full-time employees to function as “flow facilitators,” with their primary task to streamline logistical challenges in the ED, with the goal of decreasing wait times and increasing physician satisfaction. Emergency physicians were then surveyed to evaluate the changes in their self-reported satisfaction after implementation of an ED flow facilitator. Objective metrics of patient satisfaction and favorable outcomes (left-without-being-seen rates/wait times) were also assessed, as well as identifying specific areas for further improvement by the existing flow facilitators.

Results

Physicians overwhelmingly responded positively to the program, with the most consistent positive responses directed toward perceived improvement in logistical challenges over clinical challenges. Over 85% of physicians agreed that the program had improved their overall well-being. The specific throughput metrics showed that for computed tomography, ultrasound, and X-ray study, the time for order placed to results obtained decreased significantly. There was also an increase in average ED census and, based on increasing number of patients, the time to admission from ED triage decreased. The ED time to discharge and left without being seen did not significantly change.

Conclusions

Physician well-being and ED overcrowding are important issues with high financial, as well as emotional, costs. The introduction of flow facilitators to the ED seems to be an effective, targeted intervention to address physician well-being and improve radiology result times.