Nassau University Medical Center - “Strategies to Prevent ED Overcrowding”
Nassau University Medical Center (NUMC), a Level I trauma center, experienced 74,331 patient visits in the emergency department in 2007. Patient volume continues to grow as the hospital sees spillover from several local hospitals that have closed recently. In order to handle high volumes of patients, NUMC optimized and expanded its Fast-Track process for non-critical patients, and re-allocated their faculty, staff and treatment spaces at peak times to prevent overcrowding. Moreover, new workflow policies initiated by the ER leadership allow patients to access ER treatment beds and get to the doctor sooner. The hospital also improved communications and patient through-put between the Emergency and Internal Medicine departments to ensure a smoother process for patients being admitted from the ER.
Dr. Faiz Khan, Vice Chair and Head of Academic Affairs for the Department of Emergency Medicine noted, “The biggest misconception is that ER crowding, which happens to be a nationally recognized patient safety issue, occurs because there are too many patient visits to the ER. This is false. The problem is that patients, who have been ordered by the ER physician to be admitted to an in-patient unit in the hospital, remain in the ER for far too long—leading to back-ups and delays which occupy desperately needed space and resources necessary for incoming patients.”
The ED leadership at NUMC also developed an automatic “surge alert” which occurs when there are a certain number of patients designated for admission with no available receiving beds; this prompts a series of communications protocols to verify bed status and if needed to open up new treatment areas within a certain time frame. Using non-ER spaces such as an adjacent annex area or the Post-Anesthesia Care Unit that lies dormant many hours of the day have improved patient flow. “Inpatient overcrowding should be distributed,” said Khan. “The ER has traditionally been the unit which holds and tries to care for patients when there are no available inpatient beds – but many other units can and need to do their share in taking care of patients when there is ‘no room at the inn’ – so to speak. Sharing this responsibility by other units has been shown to improve patient care and safety.”
Dr. Khan estimates, through direct observation over the past 2 years, many of the above strategies have cut total ER length-of-stay by at least a half-hour to an hour.
According to Khan, the hospital is changing its triage process to a physician-driven system that ensures a physician or physician’s assistant is available to treat and release patients directly from the triage area. In addition, ED leadership is implementing 100% bedside registration to get patients seen by a doctor even sooner. Dr. Khan adds, “Since more than 90% of admissions are generated through the ER, an optimally functioning ER translates into the best patient care - and just as important, lends itself to the fiscal health of the institution. It’s a win-win situation.”