Should You Close Your Waiting Room? Addressing ED Overcrowding Through Education and Staff-Based Participatory Research
Introduction
The purpose of this project was to develop operational criteria to “close the ED waiting room”.
Methods
A prospective, staff-based participatory research model was used. Nurses at an urban ED with 70,000 visits attended a four-hour workshop concerning ED overcrowding. The workshops consisted of two parts, (1) educational sessions that reviewed key concepts of ED overcrowding, followed by (2) discussions of a proposal to “close the waiting room” as a means to decrease overcrowding. During the discussions, nurses were asked to develop guidelines to safely and consistently “close the waiting room.” The investigators defined the waiting room as “closed” when (1) ambulatory patients could be taken directly to a room or hallway space for bedside triage, registration, and initiation of care, or (2) patients were triaged in the waiting room and then taken directly to a care space for registration at the bedside. The primary outcome measure of the project was the development of guidelines to open (use) or close (not use) the ED waiting room.
Results
Seventy three of 100 nurses participated in the workshops. ED waiting room closure criteria were developed as 4 “Questions to Guide the Use of the Waiting Room.” These dichotomous (yes/no) questions reflected issues of available staff, available care space (traditional ED bed spaces and designated hall spaces), patient acuity, and additional surge capacity.
Discussion
Staff-based participatory research was an effective method to design an operational change. Nurses developed four explicit criteria describing when the waiting room should be closed.
Chicago, Ill, and Albany, NY
For correspondence, write: Paula Tanabe, Northwestern University, 259 E. Erie, Suite 100, Emergency Medicine, Chicago IL 60611
This project was supported by the 2005 Emergency Medicine Foundation and Emergency Nurses Association Foundation Team Grant. Dr. Tanabe was partially supported by a grant from the Illinois Department of Healthcare and Family Services to Northwestern Memorial Hospital under the Excellence in Academic Medicine Act.
Portions of this project were presented at the Scientific Assembly of the American College of Emergency Physicians on October 15, 2006, in New Orleans, Louisiana.
ABSTRACT