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To Reduce Emergency Department Boarding and Hospital Crowding, Look Beyond the ED

By ACEP Now | on November 13, 2016 | 2 Comments
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EL: That is absolutely correct. So what is the alternative today? Let’s build more beds. The average hospital bed occupancy in the United States is much lower than in any industrialized countries. In the US, it’s about 66 percent on average. One-third of our hospitals are empty, and yet we are overcrowded. That’s everyday life compared to Canada, for example, when their average bed occupancy is 90 percent. We have this luxury of having a lot of beds, and yet we are overcrowded. Building more beds would not solve the problem.

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ACEP Now: Vol 35 – No 11 – November 2016

PV: Some hospitals reading this will say, though, that they run at an average occupancy of 85–90 percent. Would this apply to them?

EL: Cincinnati Children’s census is about 90 percent. That’s the same as in Canada. In Canada, when we started working with the Ottawa Hospital on these issues, they reported their census in excess of 100 percent. If your average bed occupancy is 85 or 90 percent, then every peak in census hits the ceiling. Every peak means that emergency patients are going to be boarded, quality of care is diminished, and yet the next day’s valley will result in waste. In short, hospitals lack capacity because of the way they choose to do business.

PV: What does it take to make this happen? Why isn’t every place adopting this?

EL: That’s a key question. The answer is multi­factorial. First and foremost, if the hospital does not have an inspired and committed leadership, it’s not going to happen. If the hospital CEO, personally, is not supportive of this intervention, it’s not going to work. Second, surgeons do not realize that if they agree to smoothing, they would increase their volume, reduce their overtime, and improve their and patient satisfaction. At Cincinnati Children’s, despite a one-third reduction in waiting time for emergent and urgent surgery, they increased the number of cases and yet the overtime dropped by 57 percent.

“When I say that Cincinnati Children’s was able to improve their margin by $100 million a year, hospitals of similar size that do not do that will waste $100 million a year. In terms of safety, cost, readmission rates, and mortality rates, it’s dangerous to the patient and the financial wellbeing of the hospital to ignore these peaks and troughs. I consider this an absolutely essential part of any effort to address crowding. Without it, you will not solve your problem.” —Eugene Litvak, PhD

PV: I think the principle could be said, by a surgeon, that you don’t cure constipation by adding more colon.

Pages: 1 2 3 4 5 6 | Single Page

Topics: BoardingCrowdingEmergency DepartmentEmergency MedicineEmergency PhysicianHospitalInpatient CarePractice ManagementQuality & SafetyWorkforce

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2 Responses to “To Reduce Emergency Department Boarding and Hospital Crowding, Look Beyond the ED”

  1. November 29, 2016

    Kurt Knochel Reply

    On October 18, 2016 Cincinnati Children’s hospital board of trustees approved construction to increase beds by 33%. Here is link: http://www.cincinnati.com/story/news/2016/11/10/cincinnati-childrens-boost-beds-33/93598474/
    This directly contradicts the interview.

    • December 8, 2016

      Eugene Litvak, PhD Reply

      The following three links contain the relevant data:

      1. “Improvements in efficiency have boosted our capacity by the equivalent of a $100 million, 100-bed expansion and increased income from treatment of patients by even more” at http://www.jointcommissioninternational.org/assets/1/14/MPF09_Sample_Chapter.pdf (PDF,
      page 111).

      2. “No waiting: A simple prescription that could dramatically improve hospitals — and American health care” at http://www.boston.com/bostonglobe/ideas/articles/2009/08/30/a_simple_change_could_dramatically_improve_hospitals_ndash_and_american_health_care

      3. “James Anderson, adviser to the president at Cincinnati Children’s Hospital, said IHO helped that hospital improve revenues by 34 percent and avoid spending $100 million on a planned patient tower it no longer needed. Anderson, the hospital’s former president and CEO, said waiting times in the ER and OR also dropped.” Available at ttp://www.chicagotribune.com/lifestyles/health/sc-eugene-litvak-health-0504-20160502-story.html

      As you can see from the above materials, these changes have been implemented 10 years ago and saved $100 million in avoided capital cost alone. I would assume patient volume increased since then. I would be unreasonable to state that this (or any other) intervention eliminates bed needs FOREVER.

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