Crowding and Boarding
- The Institute of Medicine, in its landmark report The Future of Emergency Care in the United States Health System, called national attention to the effects of ED crowding on emergency services.1 Although this report was instrumental in raising the issue of crowding to legislators and other policy makers, we in the nursing profession have long known of the detrimental effects of overstressing our emergency care systems. Both the Emergency Nurses Association (ENA) and the American College of Emergency Physicians have published position papers on the impact of crowding on emergency care.
- A coordinated physician response during a disaster is challenging in an academic medical center environment because of the size of the institution and variety of specialty services provided. As a result of internal and external drill debriefings, it became evident that there was an acute need to better organize physician response efforts at our institution. Previously, physicians were directed to respond to one physician coordination center located in the adult emergency department. This strategy led to chaos in an already congested area.
- In our facility an operational process intervention was implemented to decrease overcrowding. The intervention consisted of implementing criteria (developed from a series of 8 interactive workshops led by the investigators with all charge and staff nurses) describing when we should “close the waiting room.” The purpose of this study was to explore the charge nurses’ perceptions of the intervention and their experiences with implementation several months after the operational change began.
- The purpose of this project was to develop operational criteria to “close the ED waiting room”.
- ED overcrowding has been gaining national attention in recent years. It is becoming apparent that, like the canary in the coal mine, ED conditions are emblematic of systemwide health care failures: too many patients, not enough room, inadequate resources, and inadequate reimbursement. The causes of ED overcrowding are myriad, but government reports1 and most ED directors agree2 that the inability to move admitted patients to an inpatient bed critically compromises the ED mission of caring for incoming acute patients.