University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Emergency Medicine


Dr. Laura Witte


Emergency Department (ED) crowding is problematic, and the challenges to resolution are complex. Specific reasons driving ED crowding are unique to the given facility, and the ideal approach to solution is dependent upon overcoming hospital-specific barriers and resource limitations. However, key steps have been identified that, when enacted, can decrease the number of patients being held in the ED. These steps include prioritizing inpatient discharges early in the day, ensuring patient discharges occur on weekends, and clear protocol for steps to be taken when a hospital exceeds their inpatient threshold. Organization-specific characteristics such as identification of ED crowding as a problem, transparency, multi-disciplinary team(s) addressing ED quality issues and focusing on ED length of stay, management support, and commitment to on-going process improvement will be instrumental irrespective of actions taken.

Models of success at institutions can serve as templates for those EDs where length of stay remains problematic. EDs that were most successful in improvement have a high level of executive leadership commitment, performance accountability, and data driven management. ED crowding will only increase as demands on the healthcare system increase. Areas of future research will continue to bring light to process or system improvements to combat this problem and will in turn serve to positively impact patient care and ED efficiency.


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