Saturday, June 26, 2010

Emergency Department Crowding Still an Issue in 2010

In September, 2001 I wrote a letter to OSF-SFMC CEO Keith Steffen regarding my concerns regarding the danger of ED overcrowding at OSF. I thought the patients were in danger due to long waits in the ED.

I was put on probabtion the next day and fired three months later.

During the following nine years I have followed the Emergency Medicine literature regarding solutions for ED crowding.

The following few paragraphs were written by Dr. Shari Welch in the June, 2010 issue of Emergency Medicine News.

ED overcrowding is an issue that all medical center administrators need to understand and be proactive to protect their patients and their community.


Dr. Welch:

Another innovation, the Full Capacity Protocol, shows that patients can be safely boarded in hallways upstairs with excellent results when all hospital beds are full.

A patient with a hip fracture would be boarded on the orthopedics floor, a TIA patient would be boarded on a neurology floor, and so forth.

Peter Viccellio, MD, at the State University of New York at Stony Brook has written several articles demonstrating that there is no increase in the mortality rate and that length of stay is shortened when patients are boarded upstairs instead of the ED. (Many of Dr. Viccellio's articles are available on; type “Viccellio” in the search box.)

Patients actually spend very little time in the hallways upstairs; somehow the system finds a bed for them. Boarding on the floor is usually done with the patient occupying an actual hospital bed. It is quieter than the ED, and patient satisfaction improves with the adoption of the policy and procedure. A copy of the full capacity protocol is available on Dr. Viccellio's web site (

Another cause of delays is patients occupying beds waiting for a resident workup. Just say “no!” It might be possible to allow this practice in an Express Admission Unit, but admitted patients must not occupy precious ED beds for the convenience of the house staff.

Boarding admitted patients in the ED is bad for patients, bad for departments, bad for the community, considering the direct connection between boarding and diversion. Low-acuity patients at your door have little to do with the solutions to boarding. Boarding relates to flow, and is a system problem with system solutions.

Improving admission operations is the one thing you cannot fix in a vacuum. Start by educating the leadership of your organization about the bad outcomes associated with boarding. Introduce them to data-driven solutions that are system solutions. Show them the compelling data on the subject.

Above all, be vigilant about ED bed minute utilization. ED bed minutes are for diagnosing and treating patients, not boarding them!

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