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Hospital and Health System

STORY OF THE WEEK

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Moving Critical Patients to Appropriate Floors Solves ED Overcrowding

A new report from Press Ganey finds that the gridlock in EDs is caused by the lack of inpatient beds in hospitals, not patients with non-urgent medical conditions. Responding to the 2009 Pulse Report on EDs, Dr. Nick Jouriles, president of the American College of Emergency Physicians (ACEP), agrees that improving patient flow is the key to alleviating dangerous crowding.

“’Boarding’ is the cause of crowding in EDs,” said Dr. Jouriles. “It occurs when hospitals ‘hold’ emergency patients who have been admitted to the hospital from the ED. When a patient is boarded, emergency physicians and nurses must continue to monitor that patient, preventing them from attending to new emergencies arriving at the hospital.”

ACEP in 2008 released high-impact, low-cost solutions to boarding. Some of the recommendations were featured in the Press Ganey report:

Move admitted patients out of the ED to inpatient areas. With each unit taking a small number of patients, the burden of boarding is more evenly spread, thus enabling the ED to better care for emergencies — without unduly stressing the inpatient units.
Coordinate the discharge of hospital patients before noon. Research shows that timely departure from the hospital can significantly improve the flow of patients in EDs by making more inpatient beds available to emergency patients.
Coordinate the scheduling of elective patients and surgical cases. Studies demonstrate that the uneven influx of elective patients (heaviest early in the week) is a prime contributor to exceeding capacity.

In a related step aimed at tackling the problem, an ACEP survey found that crowding from inpatient boarding is the leading patient-safety concern among nearly 3,000 (2,902) responding emergency physicians. Two-thirds (65 percent) of emergency physicians rated crowding as their top concern (among 16 total), followed by availability of consultants (50 percent) and nursing shortages (39 percent).

According to the report, wait times in EDs declined on average by 2 minutes to 4 hours and 3 minutes in 2008. Dr. Jouriles said that any reduction in ER wait times is good, but it is important to view research in the context of other research. Dr. Jouriles also said that the patient satisfaction scores confirms what other surveys have found. “Despite overcrowding and the problems facing emergency patients, the public needs and continues to seek emergency care and continue to be satisfied with the care they get,” said Dr. Jouriles.

Emergency visits hit a new high in 2006 — up to 119.2 million, up from 96.5 million in 1995 — that’s 300,000 per day. Demand is up by nearly a third (32 percent) over the past decade, but hundreds of EDs have closed (by 5 percent in 10 years), resulting in fewer resources for everyone. Emergency care is highly efficient and cost effective, representing less than 3 percent of the $1.5 trillion the nation spends on healthcare.

Source: American College of Emergency Physicians, June 23, 2009

Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time

During this webinar, three industry insiders described the strategies that their organizations have implemented to improve throughput in the ER to increase efficiencies, reduce costs and improve patient outcomes and satisfaction.

Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time is available from the Healthcare Intelligence Network for $277 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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IMPORTANT NOTICE: This information is designed to provide accurate and authoritative information on the business of healthcare. It is distributed with the understanding that Healthcare Intelligence Network is not engaged in rendering legal advice. If legal advice is required, the services of a competent professional should be retained.