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Chapter 15 - Overcrowding, Triage, and Care Rationing

Published online by Cambridge University Press:  20 July 2023

By
Samita M. Heslin  and
Peter Viccellio
Edited by
Mark Curato ,
Kaushal Shah  and
Christopher Reisig
Mark Curato
Affiliation:
Weill Cornell Medicine, New York
Kaushal Shah
Affiliation:
Weill Cornell Medicine, New York
Christopher Reisig
Affiliation:
Weill Cornell Medicine, New York
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Summary

Emergency Departments (EDs) nationwide face overcrowding problems. This is particularly problematic in the urban milieu because of a large volume of patients, smaller physical footprint of EDs, more low-acuity cases, and increased cases needing additional services, such as social services. Overcrowded EDs have negative impacts on patient care and patient safety. There are several solutions to ED overcrowding. Hospital-level solutions include smoothing elective admissions across the week; discharging patients earlier in the day; discharging patients on the weekends; and the Full Capacity Action plan. ED-level solutions include incorporating a Team Triage model; improving radiology turnaround times; improving availability and timeliness of ancillary services; and improving timeliness of consultants.

Keywords

Overcrowdingboardingtriagethroughputelective admissionsdischargesFull Capacity Protocolteam triage
Type
Chapter
Information
Urban Emergency Medicine , pp. 184 - 190
Publisher: Cambridge University Press
Print publication year: 2023

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References

U.S. Department of Health and Human Services – Office of the Assistant Secretary for Planning and Evaluation. Trends in the utilization of emergency department services, 2009–2018. 2021. https://aspe.hhs.gov/sites/default/files/private/pdf/265086/ED-report-to-Congress.pdfGoogle Scholar
CDC National Center for Health Statistics. Almost half of hospitals experience crowded emergency departments. September 27, 2006. www.cdc.gov/nchs/pressroom/06facts/hospitals.htmGoogle Scholar
McKenna, P, Heslin, SM, Viccellio, P, Mallon, WK, Hernandez, C, Morley, EJ. Emergency department and hospital crowding: causes, consequences, and cures. Clin Exper Emerg Med. 2019;6(3):189.Google Scholar
Singer, AJ, Thode, HC Jr, Viccellio, P, Pines, JM. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011;18(12):1324–1329.Google Scholar
Weiss, SJ, Ernst, AA, Derlet, R, King, R, Bair, A, Nick, TG. Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. Am J Emerg Med. 2005;23(3):288–294.Google Scholar
Reznek, MA, Murray, E, Youngren, MN, Durham, NT, Michael, SS. Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding. Stroke. 2017;48(1):49–54.Google Scholar
Fee, C, Weber, EJ, Maak, CA, Bacchetti, P. Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia. Ann Emerg Med. 2007;50(5):501–509.Google Scholar
Pines, JM, Hollander, JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51(1):1–5.CrossRefGoogle ScholarPubMed
Hwang, U, Richardson, L, Livote, E, Harris, B, Spencer, N, Sean Morrison, R. Emergency department crowding and decreased quality of pain care. Acad Emerg Med. 2008;15(12):1248–1255.Google Scholar
Horwitz, LI, Green, J, Bradley, EH. US emergency department performance on wait time and length of visit. YMEM. 2010;55(2):133–141.Google Scholar
GAO-09–347 Hospital Emergency Departments: Crowding Continues to Occur, and Some Patients Wait Longer Than Recommended Time Frames. Washington; 2009.Google Scholar
Centers for Disease Control and Prevention. QuickStats: percentage of emergency department visits with waiting time for a physician of > 1 hour, by race/ethnicity and triage level – United States, 2003. Morbidity Mortality Weekly; 2006.+1+hour,+by+race/ethnicity+and+triage+level+–+United+States,+2003.+Morbidity+Mortality+Weekly;+2006.>Google Scholar
Pines, JM, Pollack, CV Jr, Diercks, DB, Chang, AM, Shofer, FS, Hollander, JE. The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med. 2009;16(7):617–625.Google Scholar
McCusker, J, Vadeboncoeur, A, Lévesque, JF, Ciampi, A, Belzile, E. Increases in emergency department occupancy are associated with adverse 30-day outcomes. Acad Emerg Med. 2014; 21:1092–1100.Google Scholar
Richardson, DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184:213–216.Google Scholar
Sprivulis, PC, Da Silva, JA, Jacobs, IG, Frazer, AR, Jelinek, GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006;184:208–212.CrossRefGoogle ScholarPubMed
Honigman, LS, Wiler, JL, Rooks, S, Ginde, AA. National study of non-urgent emergency department visits and associated resource utilization. West J Emerg Med. 2013;14:609–616.Google Scholar
Durand, AC, Gentile, S, Devictor, B, Palazzolo, S, Vignally, P, Gerbeaux, P, Sambuc, R. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. Am J Emerg Med. 2011;29:333–345.CrossRefGoogle ScholarPubMed
Butler, C. How surgical smoothing could help ease the medical backlog created by COVID-19. CBC News. 2020, July 13. www.cbc.ca/news/canada/london/elective-surgery-wait-times-covid-surgical-smoothing-1.5641819Google Scholar
Olsen, L, Saunders, RS, Yong, PL (eds.). The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. National Academies Press; 2010.Google Scholar
O’Dell, K. St. John’s cuts errors, increases efficiency. News-Leader, 2006, July 5.Google Scholar
Viccellio, P, Hochman, KA, Semczuk, P, Santora, C. Right focus, right solution: how reducing variability in admission and discharge improves hospital capacity and flow. In: Litvak, E (ed.). Optimizing Patient Flow: Advanced Strategies for Managing Variability to Enhance Access, Quality, and Safety. The Joint Commission; 2018: 97–112.Google Scholar
Garson, C, Hollander, JE, Rhodes, KV, Shofer, FS, Baxt, WG, Pines, JM. Emergency department patient preferences for boarding locations when hospitals are at full capacity. Ann Emerg Med. 2008;51:9–12.Google Scholar
Viccellio, P, Zito, JA, Sayage, V, Chohan, J, Garra, G, Santora, C, Singer, AJ. Patients overwhelmingly prefer inpatient boarding to emergency department boarding. J Emerg Med. 2013;45:942–946.CrossRefGoogle ScholarPubMed
Willard, E, Carlton, EF, Moffat, L, Barth, BE. A full-capacity protocol allows for increased emergency patient volume and hospital admissions. J Emerg Nurs. 2017;43:413–418.Google Scholar
Boyle, A, Viccellio, P, Whale, C. Is “boarding” appropriate to help reduce crowding in emergency departments? BMJ. 2015;350:h2249.CrossRefGoogle Scholar
Viccellio, A, Santora, C, Singer, AJ, Thode, HC Jr, Henry, MC. The association between transfer of emergency department boarders to inpatient hallways and mortality: A 4-year experience. Ann Emerg Med. 2009;54:487–491.Google Scholar
Heslin, SM, Francis, A, Cloney, R, Polizzo, GM, Scott, K, King, C, Viccellio, P, Rowe, AL, Morley, EJ. Team triage increases discharges and decreases time to discharge without increasing test ordering. J Am Coll Emerg Phys. 2021:2(1):e12311. doi:10.1002/emp2.12311Google Scholar
Hagland, M. At Jefferson Health, a success story around ED Teletriage that offers hope. Health Care Innovation. 2020, March 21.Google Scholar

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