Adoption of Interventions to Address ED Crowding, 2007–2010

Daniel M. Lindberg, MD reviewing Warner LSH et al. Health Aff (Millwood) 2015 Dec 1.

The most crowded hospitals adopted more interventions, but a significant gap in adoption persists.

Several interventions (such as bedside registration, use of a fast track, and boarding of patients in inpatient, rather than emergency department [ED] hallways) have been shown to decrease ED crowding and to improve efficiency and patient safety. The National Hospital Ambulatory Medical Care Survey (NHAMCS) — a longitudinal probability sample of U.S. ED visits — began measuring adoption of 17 such interventions in 2007. Using NHAMCS data, these authors assessed adoption of each intervention in relation to ED crowding. Participating hospitals were categorized into quartiles of crowding based on median ED length of stay.

Between 2007 and 2010, the average number of interventions adopted increased from 5.2 to 6.6, with more-crowded EDs adopting significantly more interventions. The use of protocols to address times when a hospital is at full capacity increased from 21% to more than 46%. Surprisingly, the only intervention to show a significant decline was the use of observation units, which dropped from nearly 36% to 21%. Of the most crowded EDs, nearly 20% were still not using bedside registration in 2010, and 84% did not board patients in inpatient hallways.

CITATION(S):

Warner LSH et al. The most crowded US hospital emergency departments did not adopt effective interventions to improve flow, 2007–10. Health Aff (Millwood) 2015 Dec 1; 34:2151.