Gridlock page’ helps clear crowded ED

Sometimes, you have to look beyond the walls of your ED for solutions to your overcrowding problems, says Sandy Vecellio, RN, BSN, clinical manager of the ED at Gwinnett Medical Center in Lawrenceville, GA. And when things really get rough, she advises, send out an SOS.

Vecellio’s ED is tackling the root problem of overcrowding and boarding patients by trying to get patients moving more efficiently through not just her department, but the entire hospital.

The idea is that most of the backup in her ED is caused not by anything her staff is or isn’t doing, but by what’s going on in other areas, she explains. When one floor is slow to discharge patients, those beds aren’t available for new admissions, and eventually that slowdown will result in patients stacked up in the ED.

So the Gwinnett Medical Center ED uses a "gridlock page" to alert others that ED overcrowding is getting out of hand. The basic message is: "Hey! We’ve got patients stacking up here. Help us by moving your patients out faster."

"When the hospital is full and we’re holding patients in the ED, we send out a gridlock page that goes to the beeper of all the managers on the floors," she explains.

Those manager confer with their charge nurses and look for patients who can be expedited with faster discharges, Vecellio says. "They might call the physician and ask if this patient can go," she says. "With the page, we’re asking them to be more proactive at that point because they know we’re in a critical situation."

Fax alerts doctors’ offices

At the same time the managers’ beepers are going off, the ED staff also sends a mass fax to physicians’ offices to alert them to the gridlock. The fax asks that they come to the hospital and make rounds earlier than usual and try to discharge patients as quickly as possible.

"We get good response from some physicians, and some don’t respond much at all," Vecellio adds. "That’s to be expected, but any response helps."

The hospital’s admissions nurses determine when to initiate the gridlock page. They consider not only the situation in the ED, but also the hospital’s surgery schedule.

"We have at times needed almost 50 beds, and patients just had nowhere to go. We’ve had days when patients were coming out from surgery, and we were already holding 21 patients in the ED as well," Vecellio continues.

"Any time the ED is holding three or four patients and we also have surgery patients coming out, they will go ahead and do the gridlock page," she adds.

Sometimes the admissions nurses will be proactive and do just a warning page, to alert the other units that only a few beds are left.

Gwinnett Medical has been using the gridlock page for about a year employing it about twice a week. The results have been good, she says.

The ED has almost 90,000 visits per year, and the hospital has only 200 bed, "so our ED volume does not match our bed capacity," Vecellio notes. "We have to do a lot creative things."

Managers meet to brainstorm

Another strategy for clearing gridlock in the ED is the hospital’s "intake capacity team," which was formed four months ago and meets monthly. Prompted by the realization that ED gridlock doesn’t start in the ED, the hospital created the team to bring together managers from each treatment area of hospital, a case manager, the director of housekeeping, and leaders from radiology and the laboratory.

The hospital’s chief of operations runs the meeting. Vecellio says this situation is better than the ED manager taking charge, which could breed resentment if other managers thought the ED leader was trying to boss other departments.

"We all come together and figure out where we have process issues that need to change," Vecellio points out.

One problem was beds were not being cleaned quickly enough. The hospital added positions so they had enough staff to turn over those beds quickly when the ED needed them, she says. "We also decided to keep the admission unit open 24 hours a day and increased staff to make that possible," Vecellio says,

Another change addressed the cath lab. Cardiology was admitting patients at the end of the day because the staff of the cath lab already had gone home; the patients had to stay overnight and wait for the cath lab to open the next day. Because the situation took up precious bed space, the hospital extended the cath lab hours.

"A lot of things come out of these meetings that don’t involve changes in the ED, but we change things in other parts of the hospital that have the effect of freeing up those beds and moving patients through the ED faster," Vecellio stresses. "You have to look beyond the ED for solutions."

[Editor’s note: Have other ideas for battling gridlock in the ED? Send your suggestions to Greg Freeman, Editor, ED Management, 3185 Bywater Trail, Roswell, GA 30075. Telephone: (770) 998-8455. E-mail:]


For more information on battling ED gridlock, contact:

  • Sandy Vecellio, RN, BSN, Clinical Manager of the ED, Gwinnett Medical Center, 1000 Medical Center Blvd., Lawrenceville, GA 30045. Phone: (678) 442-4321.