5 Ways to Improve Emergency Department Overcrowding

Emergency department overcrowding is not an unusual phenomenon. Hospitals across the country are struggling to assist every patient admitted into the emergency room as the number of patient visits to the emergency department increases. Robert Takla, MD, chair and medical director of Emergency Medicine at St. John Hospital and Medical Center in Detroit, worked with professionals inside and outside of the hospital to clamp down on ED overcrowding. Combined efforts led to significant improvements in the hospital's overall efficiency. Here are five ways the improvement was achieved.

1. Recognize the problem. The imagery is all too familiar: three-ring binders that are inches thick are filled with physician contact information that oftentimes doesn't help to get in touch with those physicians when they are needed. Terry Edwards, CEO of clinical communications system PerfectServe, worked with St. John and Dr. Takla to improve communication between on-call physicians and ED staff. Mr. Edwards says hospitals have long struggled with improving communication. "Communication problems have existed for a long time, and industry has just put up with it," Mr. Edwards says. "The market's beginning to recognize the problem and the need to fix it."

2. Consider implementing an automated communication system. Automated systems, such as PerfectServe, can improve communication by removing variation and cutting down on time spent trying to locate physicians. Automated systems aggregate information on physician call schedules and contact information, allowing ED staff to dial into the system, which then automatically contacts the appropriate physician using his or her preferred form of communication.

3. Require everyone's cooperation. Dr. Takla recognizes that the strides the hospital has made in hospital efficiency could not have been possible if not for the cooperation of the entire hospital staff. Bottlenecking in the ED, the hospital realized, was a direct result of not clamping down on patient length of stay and the availability of hospital beds. "If we can alleviate that bottleneck, throughput would improve," Dr. Takla says. "Internal medicine, radiology — everyone stepped up to the plate. All those things together made our capacity better."

4. Avoid bottlenecking in the observation unit. The clinical decision unit, or observation unit, was one approach St. John Hospital used to improve bed availability and alleviate bottlenecking. CDUs have traditionally been managed in a private practice fashion, where the observation of the patient was carried out by the admitting physician or primary care physician. For example, if 30 patients were in an observation unit at one time, they would have been under the supervision of 30 or so physicians, which Dr. Takla says is not the most efficient model. "There's too much variability," he says. "Physicians don't have the time to be immediately available for results and are occupied doing other things." St. John Hospital decided to reform its CDU model in an effort to help reduce the length of stay in the unit by putting a physician in charge of it. The model contributed to shortening the ED length of stay from door-to-inpatient bed for admitted patients from an average 10 hours to 5.8 hours because the throughput efficiency in the observation unit improved, allowing more beds to become available.

5. Communicating with primary care physicians. One fundamental focus in St. John Hospital's efforts in reducing ED overcrowding is emphasizing the primary care physician. Dr. Takla comments that enhanced communications not only helped improve efficiency but also patient safety as well as patient and physician satisfaction.

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