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Strategies for Resolving Emergency Department Overcrowding Issues

This presentation discusses overcrowding in Emergency Departments (ED) and provides strategies to address the issue. Key points include improving operational management, standardized metrics, and reducing demand for intensive care units. The importance of collaborative hospital-wide approaches and the need for efficient patient flow are highlighted to tackle ED overcrowding effectively.

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Strategies for Resolving Emergency Department Overcrowding Issues

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  1. ED = Damage Containment Zone Presentation by Duncan Stuart Frank Daly, Amanda Ling 27 July 2006

  2. USA overcrowding Similar problem and strategies to down-under • Standardise metrics for benchmarking workloads • Improve operational management • Tougher funder/accreditation standards & penalties

  3. Operational management • No single magic bullet – need package • Redesign, lean thinking etc etc • ED benchmarking data • Prediction, queuing theory, smooth scheduled admissions • Schedule discharges • Hospitalist role • Reduce demand for ICU • Rapid response teams(MET)

  4. ED internationally accepted politically as “damage containment zone”for whole-of-system poor planning & under-funding

  5. Model of care planning wrong = ED LOS pays the price • Chest pain • 6-10 hour troponins routine practice • Acute abdomen • Routine CT before surgeon will see • O&G • similar increased reliance ultrasound • Observation Units • 5 beds per 10,000 presentations • Increase ED imaging and path support

  6. On current bed utilisation(without factoring in the new tech/defensive medicine shifts in practice • Not enough beds available at all stages of the care continuum • Major acute bed shortages • SE Qld 1000 acute beds (Pagan, QH) • Australia 4,000 acute beds (Dean, HRT)

  7. How to Solve ED Over-crowding • “Burning platform” (crisis) makes change happen faster ….. but • Only ED has a burning platform • Only wards can fix ED crowding • “Over-crowding is a hospital-wide problem” – rhetoric needs some teeth … • Wards and ED need equal burning platform !

  8. Consequences of ED over-crowding • Emergency medicine dying as attractive specialty • Increased LOS in ED and wards • Increased staff dissatisfaction and loss at a time of national workforce crisis • Increasing ED over-crowding

  9. Enough is enough !!!! Its time to “speak softly and carry a big stick”

  10. Al Capone solves ED over-crowding … • “you can get a lot further with a kind word and a gun than a kind word alone” (IHI teleconference 27/7/06) • All cities with recurrent ED over-crowding to now adopt Perth’s “No diversion, no ramping” ED-led over-crowding management strategy for three months trial (winter)

  11. Perth constant ED overcrowding • Nothing being done …. • In severe crisis, RPH’s ED patients sent to wards “over-census” • Ambulance pressure ED Directors to avoid ramping • Longer ED stays and outliers increase inpatient LOS increases ED overcrowding

  12. “no diversions, no ramping”(Full Capacity Protocols – Sunnybrook USA studies) • DG implements “no diversions, no ramping” 3 month trial on recommendation of ED Directors of RPH and SCGH • Share the load/urgency across hospital and all hospitals simultaneously: • Ambulance diversions “let hospitals off the hook” for good bed management !! • Buy time to implement 17 other programs and strategies in parallel e.g. HITH, etc

  13. National ED overcrowding strategy • Wards must take over-census patients (Perth) • Three stage implementation • Policy alone led to improves ward discharges! • Discharge team on weekends (SCGH) • Snr Med Reg, Pharmacist & Disch Co-ord • Pull system across continuum • Starts residential care, Discharge lounge • Ambulances “load share” cases

  14. Operate hospitals to specifications • Outliers the exception (rare) • Dangerous and inefficient • Fix maximum occupancy (85-93%?) • Standardise metrics and jargon • Access Block –which admitted patients not counted? • Immediate comparative study of various “ED sort – admit?” • Front end Transitional - “SSU”, “Obs Ward”, EMU, etc

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