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Managing Capacity to Reduce Emergency Department Overcrowding and Ambulance Diversions

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Background: Shady Grove Adventist Hospital implemented a series of housewide initiatives to decrease ambulance diversions, decrease wait times in the emergency department (ED), improve poor patient satisfaction, and decrease risks to patient safety.

Methods: Process improvement teams addressed areas affecting overcrowding and inpatient bed availability. Teams met to identify, test, and implement process changes. The ED's ability to evaluate, treat, and transfer patients requiring inpatient admission was identified as the most critical factor in reducing ED crowding and ambulance diversions.

Results: From 2003 to 2004, the hospital reduced ambulance diversion hours from 2,365 to 655—a 72% reduction. It also decreased average in-hospital and ED lengths of stay, improved ED patient satisfaction scores, and decreased the number of patients "boarding" in the ED. Increases in the number of admissions and decreases in length of stay improved financial performance.

Discussion: The initiatives helped improve access to care for the rapidly growing community. Reductions in ambulance diversions and ED overcrowding reflected a team effort, which included the executive team as well as clinical and nonclinical staff, and a holistic approach to identifying and removing throughput barriers.

Document Type: Research Article

Publication date: May 1, 2006

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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