Emergency department overcrowding has been an issue in the U.S. for some time now, but a research team at Oregon Health and Science University may have cracked the code to fixing it.

A new study published in the journal Annals of Emergency Medicine found four strategies that can reduce crowding.

"ED crowding measures are now publicly reported, and this increases pressure on hospitals to address ED crowding," Dr. Benjamin Sun, senior author and professor at the university, told HCB News. "There is increasing recognition that ED crowding is dangerous and leads to a poor patient experience."
For instance, it can result in delays in administering pain medication to patients with broken bones and antibiotics for those with pneumonia.

The research team categorized 2,619 U.S. hospitals as low, high or highest in terms of length of stay and amount of time an admitted patient waited for an inpatient bed. The data came from statistics provided to CMS.

They selected a representative sample of four hospitals in each of the categories and then systemically interviewed a wide range of stakeholders. That included 60 people at 12 hospitals in nursing, ED director, inpatient services director, chief medical office and other executive officer roles.

The four strategies they found to be effective were the involvement of executive leadership, hospital-wide coordinated strategies, data-driven management, and performance accountability.

Executive leaders at the high-performing hospitals indicated that hospital crowding is a top priority and had clear goals and resources in place to achieve them. Alternatively, executives at low-performing hospitals did not prioritize it, despite acknowledging the causes.

High-performing hospitals had an integrated system across departments to reduce crowding, but low-performing hospitals operated in silos. They also leveraged data to provide instantaneous feedback to personnel and predict patterns of flow in the ED and hospital.

"In contrast, at low-performing hospitals, data were most often available only retrospectively, and, if the data were used, they were discussed by executive leadership at monthly or quarterly meetings," the authors wrote.

Staff members were held accountable at the high-performing hospitals and issues were addressed immediately in order to reduce crowding. For example, if patients in the ED were waiting longer than the acceptable limit, the chief medical officer would go to the ward floors to review the charts and fix the problem.

"ED crowding is sign of potential opportunities to improve hospital operational efficiency and the bottom line for the hospital," said Sun.

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