Hospital, medical, and nursing staff leadership need to understand the bottlenecks and obstacles inherent in their system that contribute to ED patient boarding. Once identified, firm guidelines need to be put in place to minimize such delays, which will not only improve patient flow in the ED but also help to reduce overall hospital LOS, as well. Some hospitals have adopted a model that decentralizes the key services of transportation and housekeeping and places them under the auspices of a patient logistics area, which can more effectively monitor and control the resources to reduce extensive delays.
Prioritization of hospital resources for the emergency department. The Centers for Disease Control reported that ED patients comprised roughly 36% of all hospital admissions. Ten years later, in 2006, that percentage had skyrocketed to more than 50%. Some hospitals rely on the ED as a source of 75% of total hospital admissions, yet provide a fewer amount of resources and priorities to the ED, in terms of staffing, space, and equipment. A recent study from the Agency for Healthcare Research and Quality found that across 65 hospitals, the majority felt their emergency departments lacked the sufficient space to deliver quality patient care with a third saying the number of patients regularly exceeds their capacity to provide safe care. Nearly 67% reported that the level of nursing staff was insufficient to effectively care for patients, and 40% felt the same regarding physician staffing.
Working to reduce non-urgent visits to emergency departments. The Centers for Disease Control reported that in 2006, there were nearly 16 million ED patients who visits were considered to be "non-urgent." While this number did not change from 2005 to 2006, it is clear that there is not enough being done to find appropriate alternative locations for these patients, whose ED occupancy prevents patients with emergent conditions from easily getting timely care. Managed care companies' increase of patient co-pay and co-insurance responsibilities may have dissuaded patients from seeking care in the ED, but this alone is not going to fix the problem. Yet many patients arriving to the emergency department for sore throats and other minor complaints are often the first to complain about slow treatment, perhaps unaware that the physician they are waiting to see is busy resuscitating a patient in the room next door.
There is no short-term or easy fix. And times are getting tougher as the potential for national healthcare reform may lend itself to continued increases in visits to EDs nationally in addition to the growing problems of nursing shortages, lack of on-call coverage, and economic challenges limiting access to capital for hospitals.
Option No. 3 in addressed ED overcrowding is a combination of significant changes by communities, their physicians, and hospitals who must all do their part to alleviate the crisis. But try to tell that to any of the one of the 42,000 patients who are admitted to hospitals from the emergency department in this country each day—I think they would prefer to be held in the ED or on an inpatient floor. Ultimately, the option No. 3 mentioned above is really not an option at all; it is a necessity.
Eric Bachenheimer is director of client solutions for Emergency Medical Associates in Livingston, NJ. He can be reached at Bachenheimere@alpha-apr.com.