Anticipate and Address Variability to Manage ED Overcrowding
Disease outbreaks and mass casualty events as well as scheduled variability (eg, diminished consultant availability on weekends) can cause enormous variability in hospital bed demand. Some of this variability is highly predictable.23 The resultant surges in patient care needs can be managed by hiring a 24-hour ED flow director who is accountable for ED overcrowding, day-ahead demand-capacity matching throughout the hospital, twice-daily multi-unit bed meetings, accountable care unit strategies, and smooth scheduled variability planning.24 The individual physician must develop a “higher gear” as needed and model this for trainees and colleagues.
Explore This IssueACEP Now: Vol 38 – No 11 – November 2019
ED overcrowding should be understood by all health care professionals, administrators, and politicians to be a systemwide problem with accountability on every level, from individual emergency physicians to government officials. We should make every effort to help improve ED overcrowding. This applies both to our clinical practice and to taking on leadership roles that can affect change at the hospital and government levels. If we all adapt this mindset, I have confidence that the ED overcrowding problem will be solved.
Special thanks to Dr. Grant Innes, Dr. Howard Ovens, and Dr. Samuel Campbell for their expert contributions to the podcast that inspired this article.
ACEP has a variety of resources to help you address ED crowding and patient boarding at your hospital, including research papers, policy statements, and CME. Visit www.acep.org/administration/crowding–boarding to learn more.
- Gerster J. Brian Sinclair: a man was ignored to death in an ER 10 years ago. It could happen again. Global News. Sept. 21, 2018. Accessed Oct. 24, 2019.
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- Innes GD, Sivilotti MLA, Ovens H, et al. Emergency overcrowding and access block: a smaller problem than we think. CJEM. 2019;21(2):177-185.
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- Campbell SG, Innes GD, Magee KD, et al. A five-step program for diagnostic test addiction. CJEM 2019;21(5):576-579.
- Schechter MT, Sheps SB. Diagnostic testing revisited: pathways through uncertainty. Can Med Assoc J. 1985;132(7):755-760.
- Morton MJ, DeAugustinis ML, Velasquez CA, et al. Developments in surge research priorities: a systematic review of the literature following the Academic Emergency Medicine Consensus Conference, 2007-2015. Acad Emerg Med. 2015;22(11):1235-1252.
- Litvak E, Fineberg HV. Smoothing the way to high quality, safety and economy. N Engl J Med. 2013;369(17):1581-1583.