Recommendations to reduce crowding

Crowding icon

Too often, the need for emergency medical services outstrips the resources available, leading to crowded conditions in emergency departments

1. Optimize patient flow within the four walls of the ED

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

Fast track: 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.

Vertical patient flow: 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.

Designate an ED nurse flow coordinator: 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.

2. Activate resource and personnel management policies during times of peak crowding

Operationalize the ED’s Code Help policy: 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.

Pursue an aggressive bed management strategy within the entire institution: Utilize a “bed czar” or other mechanism that facilitates the use of inpatient beds to alleviate ED crowding during peak times.

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

3. Explore alternatives to traditional inpatient admissions

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

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

“The daily challenges that we face in the ED — the crowding, the time pressure, the unpredictable flow of patients — pushes us as a discipline to be flexible, creative and innovative. That’s just one thing that’s exciting about working in emergency medicine.”

- Emergency nurse, MENA member