Recorded presentation

Khoa H. Nguyen, MPH, Bruce Siegel, MD, MPH, and Marcia Wilson, MBA. Department of Health Policy, The George Washington University, 2021 K St., NW Suite 800, Center for Health Services Research and Policy, Washington, DC 20006, 202-530-2398, khoa@gwu.edu

Emergency Department (ED) overcrowding is a worsening problem for Americans, with implications for quality and patient safety. EDs in major safety net hospitals appear to be especially affected, reporting more overcrowding and episodes of ambulance diversion. Many factors have been cited as causes of overcrowding, including decreases in inpatient capacity, staff shortages, shortages of on-call physicians, and increased demand for services from uninsured as well as insured patients. However, the ability of hospitals to make management changes to address overcrowding has not been conclusively demonstrated. With support from the Robert Wood Johnson Foundation, the Urgent Matters project set out to reduce ED overcrowding and improve quality of care in ten safety net hospitals by focusing on operational improvements, using rapid cycle change techniques in an enhanced collaborative approach. Ten hospitals were selected via a national competitive process. Criteria for selection included safety net mission, charity care burden, indications of crowding and demonstrated organizational commitment. These ten hospitals formed a structured “learning network,” in which they worked collaboratively to assess current processes and implement initiatives to improve ED throughput and output. Each hospital formed its own interdisciplinary project team including representatives from the ED, inpatient and other services. Limited expert technical assistance and extensive web-based resources were provided to each hospital site. Progress was measured using 17 performance indicators. Many sites saw a significant reduction in the percentage of patients leaving without treatment. Nearly all reduced wait times and increased ED throughput and output. Many also reduced the frequency and duration of being on “diversion” or “bypass.” Better management of inpatient capacity and peer collaboration appear to have been critical to these outcomes. Organization-wide interdisciplinary commitment, physician participation and robust metrics were the most essential elements for achieving improvement. While many factors that drive overcrowding may be outside of a hospital’s control, there are clearly changes that safety net institutions can make to improve their performance, even in highly complex, resource-constrained environments. Some experts and observers have held that ED overcrowding can only be solved through expanded health insurance, increased primary care capacity, increased hospital funding and capacity, or relaxations of access statutes like the Emergency Medicine Treatment and Active Labor Act (EMTALA). Our work indicates that overcrowding can in large part be addressed through better hospital capacity and patient flow management, with a highly structured approach using mainly existing resources.

Learning Objectives: At the conclusion of the session, participants will be able to

1.Identify at least 10 societal and instiutional determinants of hospital emergency department overcrowding.
• Understand and articulate the various benefits and limitations of using Rapid Cycle Testing techniques in a collaborative framework to improve hospital patient flow and reduce overcrowding.
• Critically access the nature of emergency department crowding at a hospital and in their community.

Keywords: Emergency Department/Room, Health Care Quality

Related Web page: www.urgentmatters.org

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation