The current overcrowded status of the nation’s EDs is the biggest challenge claim respondents to a survey conducted recently by HealthLeaders Media (see Best EDs Focus on Flow.)

Nearly half identified overcrowded EDs as the No. 1 challenge, and more than half say overcrowding in the ED will jeopardize patient safety.

Forty six percent said overcrowding exists in their hospitals and almost 100 percent say they’ve been taking action to alleviate the problem. Just 25 percent were expanding their EDs.


According to the study, hospitals are fast-tracking less serious patients, implementing a medical evaluation triage process, coordinating with inpatient floor nurses, and streamlining registration. The report also suggested tending to the most urgent cases first, creating separate areas or freestanding buildings for less acute cases and improving coordination among providers.

The report confirms that the healthcare industry is biting its nails over already overcrowded EDs, in anticipation of accommodating the 30-to-40 million people who would be newly insured under the Affordable Care Act. A study in the Archives of Internal Medicine predicts that newly insured patients are 30 percent more likely to use an ED at least once a year than either regularly insured or regularly uninsured people.

Unfortunately, most of the “fixes” currently underway are focused right in the ED. That’s not to say there is anything wrong with that. But it has been widely acknowledged that ED overcrowding has more to do with what’s happening, or not happening, in the rest of the hospital than it does the ED.   While there are many fewer emergency rooms treating many more patients than there were just two decades ago, they get overcrowded because patients who need to be admitted to a room can’t get one. And that’s a problem caused by poor capacity management which allows unit beds to sit idle far too long.

There are many reasons why this happens, but the good news is that they can all be fixed by automating capacity management so that a hospital’s physical operations can be monitored, and managed, in real time.

What’s the condition of the ED in your hospital?


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