Addressing ED Crowding With Patient Flow Strategies

The number of ED visits has grown by 25% in the past decade, but the number of hospital EDs and inpatient beds has declined during that same time-frame, resulting in crowded conditions nationwide. Nearly half of EDs are operating at or above capacity, and few consistently achieve recommended wait times for all ED patients. The impact of ED crowding has been profound, leading to poor quality care, increased mortality rates, and lower patient and staff satisfaction. Major Findings on Improving Patient Flow In an effort to strengthen the evidence base for patient flow improvement strategies, Megan C. McHugh, PhD, and colleagues evaluated the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing ED crowding. Results were published in the September 13, 2011 Journal for Healthcare Quality. Participating hospitals implemented seven improvement strategies over 18 months as part of the collaborative. By the end of the study, four of the five hospitals had at least one fully implemented improvement strategy and had experienced modest improvements in patient flow, including reduced length of stay and fewer patients left without being seen. The improvement strategies and their impact varied considerably in the study, according to Dr. McHugh. “Several factors appeared to influence the impact of strategies, including ability to overcome implementation challenges, the timing of implementation, and the type of strategy selected. We also found that the staff time and expenses involved in the adoption of the ED strategies were highly variable.” Few studies have considered time and expenses associated with implementing patient flow strategies. In Dr. McHugh’s study, time spent planning and implementing the...