Patient Flow Enewsletter
Volume 1, Issue 2
Tuesday, January 10, 2004
The Joint Commission touched some raw nerves when it proposed standards to try to reduce ED overcrowding. Many industry experts pointed to a list of issues outside of hospitals' control as driving forces, like more ED demand and shortages of nurses and on-call physicians. We all know hospitals have also been forced to downsize inpatient capacity in response to managed care. A full inpatient enterprise often means patients forced to "board in the ED, and going on "divert" or "bypass."
But we shouldn't let hospitals off the hook. Because many simply have not focused attention and resources on what they can do better to manage patient flow in the ED and the rest of the institution. ED overcrowding is more than a social problem.
We studied dozens of hospitals and collected data on hundreds more in Urgent Matters. We were surprised at how many saw ED backups as random headaches, instead of predictable and manageable events that may affect the quality of care. Often it was seen as an "ED" problem, with little recognition of the role of ICU's and other inpatient units - places that have profound impact on patient flow. We have seen few institutions with a set of metrics designed to measure how well they were doing in patient flow and to predict logjam. When stressful conditions do occur, many hospitals are not well prepared; too many times hospital ED and staff are in crisis mode or divert status.
It doesn't have to be this way. From the Urgent Matters hospitals, we now know that committed leadership, planning and measurement can make a huge difference. In this issue of our newsletter, you'll read about the implementation of a discharge room at the Regional Medical Center at Memphis. This discharge room has not only streamlined the discharge process, but it has also reduced the average total ED throughput time. This issue also features a demonstration project at the Boston Medical Center that examines the ability to reduce ED crowding by smoothing elective surgical procedures.
We can debate the merits of new standards or regulations around ED crowding. Nobody likes new rules. But our results show that motivated hospitals can dramatically improve how they manage their existing resources. This means less crowding, and most important, better care for the patients we serve.
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Bruce Siegel, MD, MPH
Director, Urgent Matters
Research Professor, The George Washington University
Washington, DC
