ED Patient Boarding |
Emergency Department Patient Boarding
Emergency Department (ED) crowding is a nationwide crisis which affects the efficiency and the quality of patient care (Sox, Burstin, Orav, et al., 2007). A huge contribution to patient over-crowding is the boarding of admitted patients in the ED. An alternative use of time which is lost in the admitting of patients is used to treat patients who are waiting to be seen; this is seen typical in over-crowded EDs. The overcrowding of EDs result in risking patient safety and alternatives to this should be observed.
Holding admitted patients in EDs always was known to be bad for patient flow, but there is a growing body of research showing that it also harms patients. There is significant evidence which demonstrates that ED crowding due to boarding is responsible for poor outcomes (Sox, Burstin, Orav, et al., 2007). In many hospitals, it is the physician and the nurses who care for these boarders in the ED, therefore any risk which is taken falls squarely in their hands; therefore, not only does it decrease efficiency, but lawsuits may also arise ("Lawsuits may arise," 2008).
Ongoing ED overcrowding, the frequency and duration of ambulance diversions as well as the lack of available beds in the hospital are factors which lead to a limitation in care as well as access within the healthcare facility ("Take the lead," 2008). Counties typically have an average of three acute care hospitals and more than 19,494 hours of ambulance diversions in Emergency Medical Systems (EMS); because of this, locating an ED that could accept patients via ambulance is a challenge for EMS staff.
Research has suggested that increased supervision may improve patient safety (Richardson, 2006). Specific to the ED, one study showed that direct supervision of residents in the ED is significantly associated with better compliance with guidelines, regardless of level of training, but was unable to show an association with patient satisfaction. Another study identified direct supervision of non-EM residents rotating in the ED as resulting in "frequent and clinically important changes in patient care" (Richardson,...
This would include more effective use of space and transfer strategies. There needs to be available strategies to help release some of the overcrowding within ED areas, especially within the context of peak periods. Therefore, the research will look to find the most effective are to actually place these overflowing patients, where they are still in reach of ED services, while not overcrowding the actual ward itself. This research will
2010; McCarthy et al. 2009; Zimmerman 2004). These studies have also shown that a reduction in boarding numbers and crowding can eliminate or reduce these problems. After all of these considerations, the fourth step in Rosswurm and Larrabee's (1999) model for change is to design the actual changes to practice that should be implemented. In this case, this requires few additional resources other than learning materials for hospital staff to
ED Boarding Plan Emergency Department Overcrowding Due to Boarding: Proposed Solution The proposed solution for the noted problem of emergency department overcrowding due to the practice of boarding patients in the emergency department rather than admitting them to other areas of the hospital is relatively simple and straightforward. In essence, the solution that is most supported by current research is to simply cease the practice of inpatient boarding in the emergency department,
2010). While there is of course a mandate for emergency departments to provide necessary care to any individual that requires it, more efficient and effective care can be proved when crowding in the department is kept to a minimum and releases of boarded patients are made as soon as possible (McCarthy et al. 2009; Bair et al. 2010). Crowding itself was seen to have an effect on waiting room
This created problems in the care of patients that should have been admitted to other units, as well as for all patients receiving care in the emergency department on an inpatient or an outpatient basis. In addition, research was undertaken that examined alternatives to simply increasing the efficiency with which ED patients are either treated and released or admitted on an inpatient basis, and it was found that increasing staffing
But let's look at this resolution in a bit more depth. Briefly, processes like full capacity protocols, bedside registration, bypassing triage, adding staff during increased volume, setting up a separate "line" for treating simple fractures, lacerations, etc., establishing turn-around-time (TAT) goals for procedures and patients, can go a long way to begin to cure the problem of overcrowding (ACEP, 2008, p. 10). Full-capacity protocols. Here is a typical full-capacity protocol
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