Establish a point-of-care testing lab in the emergency department to process a limited set of routine tests to speed results and diagnosis.

Case studies:

• Beth Israel Deaconess Hospital Needham

Additional resources:

• Massachusetts General Hospital

Establish a “fast-track” area for patients with the lowest acuity scores, enabling them to be treated and released faster while also allowing the team to focus more time on higher-acuity patients.

Case studies:

• Boston Children's Hospital
• Lowell General Hospital
• Sturdy Memorial Hospital

Create more capacity during peak times using vertical flow, a split flow model that replaces traditional ED beds with recliners for patients with lower acuity scores (ESI-3 or lower). The use of recliners increases capacity and reduces length of stay for these patients.

Case study:

• Froedtert Hospital

Additional resources:

• Keeping Patients Vertical in the Emergency Department (Colleaga article)
• Stanford Health Care (Stanford, CA)

Use a coordinator who is empowered to expedite and facilitate the movement of patients through the ED to reduce length of stay and percent of patients who leave without being seen.

Case study:

• Baystate Medical Center

Use the hospital’s Code Help policy to temporarily reduce strain caused by crowding by bringing other hospital resources to the aid of the ED.

Utilize a “bed czar” or other mechanism that facilitates the use of inpatient beds to alleviate ED crowding during peak times.

Case study:

• Massachusetts General Hospital

Additional resources:

• Meeting Patient Flow Demands with Creative Case Management (QHR white paper)

Board stable ED patients in hallways on inpatient floors during times of crowding to reduce congestion in the emergency department.

Case study:

• Massachusetts General Hospital

Discharge patients with certain conditions from the ED to their homes with inpatient level care rather than admitting to the hospital.

Case study:

• Massachusetts General Hospital

Additional resources:

• Rapid Discharge Tool (NYC Department of Health)

Utilize mobile integrated health or community paramedicine to provide urgent treatment and, if appropriate, avoid an ED visit.

Additional resources:

• Mobile Integrated Health (Commonwealth Care Alliance)
• Principles for Establishing a Mobile Integrated Healthcare Practice (Medtronic)