Even though most crowded U.S. hospital emergency departments were adopting measures to improve patient flow, they were not adopting the most effective interventions, according to a new study in Health Affairs.
Hospitals “have been slow to adopt interventions that require a change in protocols. This may reflect the fact that ED crowding is a low hospital-wide priority in many facilities, despite the fact that it continues to worsen,” Dr. Leah Honigman Warner, attending physician in the department of emergency medicine at Long Island Jewish Medical Center, New Hyde Park, N.Y., and colleagues wrote in the December 2015 issue of Health Affairs (2015 Dec.;34[12]:2151-2159. doi: 10.1377/hlthaff.2015.0603).
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Researchers examined data collected from the Centers for Disease Control and Prevention’s National Hospital Ambulatory Medical Care Survey on emergency department crowding interventions from 2007 to 2010 and found that “while the average number of crowding interventions adopted by hospitals has increased in recent years, there is still a significant gap in the adoption of many of the strategies that can reduce ED crowding and make crowded EDs safer.”
For example, two interventions – the use of full capacity protocol and boarding in inpatient hallways – were not adopted by the majority of the most crowded quartile of hospitals. Sixty percent of hospitals have not adopted full capacity protocol, and 80% do not transfer admitted patients to wait in inpatient hallways when all beds are full, researchers noted.
To highlight the effectiveness of full capacity protocol, authors point to the Canadian province of Alberta, which adopted the measure and saw ED length-of-stay reduced by one-third and ED boarding reduced by half.
Hospitals during the study period were employing a number of other strategies, including physical space expansion, which has not been proven to help crowding, and technology-related interventions, such as the use of electronic dashboards and computer-assisted triage, both of which are growing and can help reduce length of stay.
“There are data to support the use of ED crowding interventions and proven best practices,” the researchers conclude. “Now is the time for a national campaign to develop the standards to reduce ED crowding and eliminate ED boarding, which will allow hospitals and EDs to provide the highest-quality acute care.”
The authors did not declare any conflicts of interest.