The most crowded EDs in the United States have not adopted proven interventions to address crowding, a recent study found.1 Some key findings:
19% did not use bedside registration;
94% did not use surgical schedule smoothing, which helps plan surgical schedules to match inpatient bed availability.
Leah Honigman Warner, MD, the study’s lead author and an attending emergency physician (EP) at Long Island Jewish Medical Center in New Hyde Park, NY, had hoped to see more EDs addressing crowding.
“I worry instead that a crowded ED is now the new status quo, which reduces the incentive to change,” she says.
Jesse Pines, MD, one of the study’s authors, was not entirely surprised by the findings. Pines is director of The Office for Clinical Practice Innovation at George Washington University School of Medicine and Health Sciences in Washington, DC. Addressing ED crowding is “time-consuming, costly, and requires leadership locally in the ED and within the hospital, along with staying power over time to sustain any gains in efficiency,” Pines says.
Pines says practicing EPs can reduce liability risks associated with ED crowding by:
ensuring that documentation is complete and timely, even when it’s busy;
recognizing which patients are higher risk for harm during episodes of crowding, such as the elderly and the critically ill.
Entire Hospital Affected
ED crowding can adversely affect the entire hospital, according to Warner. This calls for systemic solutions and collaboration between EPs and hospital leadership.
“There are many evidence-based interventions, both which we evaluated, as well as others that should be considered,” she says.
Some solutions simply require a change in protocol, such as EDs implementing a “full capacity” protocol to address inpatient boarding, while solutions such as surgical schedule smoothing require changes in staffing. Other interventions require more capital investment, creation of observation units, or fast tracks.
“Once we can improve crowding, we should also see better outcomes, which should reduce risk for liability,” Warner says.
Warner LSH, et al. The most crowded U.S. hospital emergency departments did not adopt effective interventions to improve flow, 2007–10. Health Aff 2015;34:2151-2159.
Jesse Pines, MD, Director, The Office for Clinical Practice Innovation, George Washington University School of Medicine and Health Sciences, Washington, DC. Email: [email protected]
Leah Honigman Warner, MD, Emergency Department, Long Island Jewish Medical Center, New Hyde Park, NY. Email: [email protected]