Hospital Systems

"An Agenda for Reducing Emergency Department Crowding"
(2005)Annals of Emergency Medicine
Increasing ICU beds was found to decrease ED length of stay for ICU bound patients and overall ambulance diversion. However, it had no effect on overall ED length of stay. Doubling the number of physician coverage during the evening shift was found to dramatically reduce the length of stay for discharged patients. The average decrease in stay was 35 minutes. The addition of a short stay unit adjacent to the emergency room along with deferral of low-risk patients to next-day care, decreased the number of patients who left without being seen and ambulance diversion by 50%. Point of care blood testing was found to reduce turnaround time by 87%, which significantly reduced the patient’s length of stay.

"Emergency Department Overcrowding and Ambulance Diversion: The Impact and Potential Solutions of Extended Boarding of Admitted Patients in the Emergency Department"
(2006)Journal of Emergency Medicine
By increasing the number of ICU beds by 43%, one institution was able to decrease their ambulance diversion hours by 66%. Future goals for solutions need to include: further research demonstrating adverse patient effects due to overcrowding; partnering of JCAHO, government agencies, and Emergency Medicine Organizations for system improvements; partnering and coordinating with outpatient services and community health centers; and public relations campaigns to increase public awareness with an emphasis that everyone can be adversely impacted. .

"Hospital Overcrowding"
(2005)Joint Commission on Accreditation of Healthcare Organizations
To successfully alleviate overcrowding, the emergency room must be considered by the hospital as an integral part of the organization. It must be willing to allocate necessary resources when the unit is overwhelmed, as well as committing to ongoing monitoring of crowding measures and patient outcomes. Effectively treating hospital overcrowding requires a multidisciplinary teamwork approach; adequate input, throughput, and output; assessment of patient flow; detection of early warning factors; and patient tracking systems

"New at E.R.’s: More Sense of Urgency"
(2006) New York Times
This article from the New York Times lists multiple causes of emergency room crowding affecting hospitals in New York and how these hospitals are planning to combat the problem within their facilities.

"Placing Emergency Department Crowding on the Decision Agenda"
(2006) Medscape
This article contains proposed solutions to EDC using the input-throughput-output conceptual model designed by Asplin et al. (2003). Multiple solutions are proposed using strategies to control the number of patients arriving in the ED, increasing efficiency of the ED, and increasing access to inpatient beds

"The Future of Emergency Care in United States Health System"
(2006) Institute of Medicine
Emergency department crowding is due to a variety of reasons including an increase in the uninsured and the lack of access to primary healthcare in rural settings. This overcrowding leads to increased boarding of patients in the ED and also an increase in ambulance diversion. The Institute of Medicine has recommended a multi-pronged strategy which includes improving hospital efficiency and patient flow; having in place a coordinated, regionalized, accountable system; increasing resources; and paying attention to children.