Emergency Department (ED) crowding has been a growing problem over the last two decades, leading to poor patient outcomes including increased rates of mortality and cardiovascular complications. A national study published in Health Affairs showed that while the average number of interventions to reduce crowding increased in the period 2007-2010, many of the most crowded EDs have not adopted certain proven interventions to improve patient flow.
On the positive side, researchers analyzing data from the National Hospital Ambulatory Medical Care Survey found that the average number of ED crowding interventions employed by hospitals increased 25%, from 5.2 in 2007 to 6.6 in 2010. The greatest areas of growth were full capacity protocol and radio-frequency identification (RFID). Full capacity protocol refers to moving ED patients to inpatient areas, including hallways, a practice that has not been associated with patient harm. RFID involves tagging patients so that their location in the ED can be tracked to improve throughput.
However, the study also identified significant gaps in the implementation of throughput interventions. Fewer than half of the crowding interventions tracked by the study had been adopted in the most crowded EDs in 2010. Sixty-percent of hospitals with the highest ED crowding had not adopted a full-capacity protocol. Approximately 84% had not implemented RFID and 94% had not instituted surgical schedule smoothing, which is the planning of surgical schedules to match availability of inpatient beds. In addition to RFID, the study authors discuss other technology-based interventions to reduce ED crowding, including bedside registration, an electronic dashboard to track ED patients, and computer-assisted triage. Other noted interventions include “fast track” areas for patients with minor illnesses and injuries, a bed czar to manage bed flow and zoned nursing, which ensures that all of a nurse’s patients are in one area, reducing the time spent moving between patient care areas.
The authors note that full-capacity protocol and surgical schedule smoothing could be implemented relatively quickly and inexpensively, requiring only changes in administrative protocols.
Hospitals interested in tackling ED overcrowding can refer to Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals from the Agency for Healthcare Research and Quality.