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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: Absolutely. Leadership and education are critical. Surgeons should be educated to appreciate the benefits of this intervention. The third reason is that in order to accomplish smoothing, hospitals should do pretty intense data analysis. Not all hospitals have these resources, and the government should do its job to invest in hospitals getting the necessary technical support. Last but not least, I think emergency physicians must do a better job of explaining to the public the real cause of overcrowding and boarding. No matter what you do in your emergency department—and I am not suggesting that emergency departments are flawless—you alone cannot resolve overcrowding. That message should be known by the public.

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ACEP Now: Vol 35 – No 11 – November 2016

PV: What would happen nationwide from implementing this intervention?

EL: The return on investment would be huge. In 2012, two leading US health policy experts, Dr. Arnold Milstein and Dr. Stephen Shortell, in their piece “Innovations in Care Delivery to Slow Growth of US Health Spending” in the Journal of the American Medical Association, estimated that national diffusion of patient-flow optimization—optimally managing patient demand and health care capacity—has the potential to reduce total US per capita spending by 4 percent to 5 percent, which is $120–$150 billion a year. This intervention does not require capital investments. Quite the contrary, hospitals that implemented this approach saved millions of dollars and many human lives.

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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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