Executive Summary: Interventions to Improve Quality in the Crowded Emergency Department

From the Departments of Emergency Medicine and Health Policy, George Washington University, Washington, DC.
Academic Emergency Medicine (Impact Factor: 2.01). 12/2011; 18(12):1229-33. DOI: 10.1111/j.1553-2712.2011.01228.x
Source: PubMed


ACADEMIC EMERGENCY MEDICINE 2011; 18:1229–1233 © 2011 by the Society for Academic Emergency Medicine
Emergency department (ED) crowding is a major public health problem in the United States, with increasing numbers of ED visits, longer lengths of stay in the ED, and the common practice of ED boarding. In the next several years, several measures of ED crowding will be assessed and reported on government websites. In addition, with the implementation of the Affordable Care Act (ACA), millions more Americans will have health care insurance, many of whom will choose the ED for their care. In June 2011, a consensus conference was conducted in Boston, Massachusetts, by the journal Academic Emergency Medicine entitled “Interventions to Assure Quality in the Crowded Emergency Department.” The overall goal of the conference was to develop a series of research agendas to identify promising interventions to safeguard the quality of emergency care during crowded periods and to reduce ED crowding altogether through systemwide solutions. This was achieved through three objectives: 1) a review of interventions that have been implemented to reduce crowding and summarize the evidence of their effectiveness on the delivery of emergency care; 2) to identify strategies within or outside of the health care setting (i.e., policy, engineering, operations management, system design) that may help reduce crowding or improve the quality of emergency care provided during episodes of ED crowding; and 3) to identify the most appropriate design and analytic techniques for rigorously evaluating ED interventions designed to reduce crowding or improve the quality of emergency care provided during episodes of ED crowding. This article describes the background and rationale for the conference and highlights some of the discussions that occurred on the day of the conference. A series of manuscripts on the details of the conference is presented in this issue of Academic Emergency Medicine.

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    • "[2] However, studies have repeatedly found boarding of admitted patients within the ED awaiting transfer to a ward bed to be the most important contributor to ED crowding . [3] [4] The consequences of ED crowding include delays in antibiotic administration [5] [6] [7] poorer pain management, [8] increased adverse events [9] and increased patient mortality . [10] Patient satisfaction also declines as ED crowding and ED patient boarding become increasingly problematic. "

    Full-text · Article · Jan 2015
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    • "The emergency department (ED) has assumed an increasingly central role in the delivery of American health care over the last quarter century [1] [2]. Providing quality care through the ED faces challenges that differ from those of office-based practice, particularly the reliance on urgent consultant backup [3] [4] [5]. "
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    ABSTRACT: Purpose: This work aimed to study the demographic features of patients with emergency department (ED) visits for ulcerative keratitis, including information on insurance coverage and on-site consultant support. Methods: Demographic features of corneal ulcers diagnosed in the ED were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes in Florida Agency of Health Care data sets for 2010. Patterns of patient encounters, including type of insurance coverage and consultant ED visits, were analyzed foremost descriptively. Result: In 2010, 2124 patients were evaluated in EDs in Florida with the primary diagnosis of corneal ulcer. Of these patients, 190 required hospital admission for further care. Thirty percent of patients discharged from the ED were seen on the weekend. About one-third of patients had no insurance (34.7%). Compared with outpatients, those hospitalized were older (54 years vs 39 years [P < .001]) and more often had insurance coverage (90.5% vs 65.3% [P < .001]). Ophthalmologists were associated with as many as 70.9% of outpatient encounters. The ratio of outpatients to those requiring hospitalization in urban areas ranged from 2.3 to 1 in counties on the west coast of Florida to 28.1 to 1 among counties in the southeast coast. Conclusion: Emergency department participation by ophthalmologist for ulcerative keratitis was relatively high. Whether the lack of health insurance affects the decision to hospitalize patients with corneal ulcers is a question that deserves further study. What influence the high proportion of uninsured ED patients will have on ophthalmologists coverage in the future may need to be addressed.
    Full-text · Article · May 2013 · The American journal of emergency medicine
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    • "In particular, ED crowding has become a common and significant issue [5-7]. The ED physical and environmental limitations and high volume of patients have made the protection of patient privacy and confidentiality even more difficult. "
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    ABSTRACT: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of “personal information overheard by others”, being “seen by irrelevant persons”, having “unintentionally heard inappropriate conversations from healthcare providers”, and experiencing “providers’ respect for my privacy”. There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction.
    Full-text · Article · Feb 2013 · BMC Medical Ethics
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