Getting patients admitted to a hospital floor reduces length of stay and congestion in emergency departments
Research Activities, July 2009, No. 347
Patients seeking care at hospital emergency departments (EDs) typically face overcrowding. In some busy EDs, it is not uncommon for patients to be treated in hallways when regular bays are full. Congestion is often related to patients waiting to be admitted to hospital floors. A new study finds that adding more beds in the ED is not the answer. Instead, improving the rate at which admitted patients are moved to hospital floors shortens patient stays in the ED and consequently reduces ED congestion. Researchers designed a computer simulation model that could replicate various ED scenarios, such as increasing beds and patients, and changing admitted ED patient departure times.
The study found that increasing ED beds with a constant ED departure rate increased the mean length of stay from 240 to 247 minutes. Shortening the ED length of stay was the key to minimizing overcrowding. The most successful way of doing this was by rapidly moving admitted patients to inpatient units. Boosting the departure rate of admitted patients decreased the ED length of stay from 240 to 218 minutes when the number of beds was kept constant. For example, in a 23-bed ED, increasing the departure rate from 1 patient every 20 minutes to 1 every 15 minutes reduced the length of stay. Such a strategy was also successful for a 28-bed ED.
Length of ED stay remained the same or increased when the number of processed patients increased without a similar increase in the rate of patient departures out of the ED. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00078). See "Adding more beds to the emergency department or reducing admitted patient boarding times: Which has a more significant influence on emergency department congestion?" by Rahul K. Khare, M.D., Emille S. Powell, M.D., M.B.A., Gilles Reinhardt, Ph.D., and Martin Lucenti, M.D., Ph.D., in the May 2009 Annals of Emergency Medicine 52(4), pp. S44-S56.