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The steps that ERs aren't taking to reduce crowding


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A study published in Health Affairs found that emergency rooms (ER) haven’t been taking steps to reduce crowding.   Between 2007-2010, the number of new anticrowding methods adopted by ERs increased by only 1.4%. Meanwhile, methods shown to work such as bedside registration and surgical schedule smoothing aren’t being used by 19% and 94% of ERs.


"Emergency department crowding is clearly linked to worse patient care and worse outcomes, including higher mortality rates, higher rates of complications, and errors," said Jesse M. Pines, MBA, MD, director of the Office for Clinical Practice Innovation, professor of emergency medicine and health policy at the GW School of Medicine and Health Sciences. "Patients also, no surprise, have a poorer patient experience. People want fast and effective care, and many of our nation's most crowded emergency departments have not addressed this problem despite the wide availability of proven interventions."


The American College of Emergency Physicians reported that in 2015, 47% of ER physicians have seen a slight increase in ER visits, with 28% have experienced a large increase. The rise is attributed in part to the Affordable Care Act, which has resulted in not enough primary physicians to meet the demands of the newly insured. As a result, more people are using the ER for their primary care, increasing wait times and crowding.


Some of the more successful steps in reducing ER crowding and wait times have been:
•    Using the “direct-to-bed” approach, where patients are brought directly to an ER bed for registration rather than in the waiting room.
•    Surgical schedule smoothing, which helps plan surgical schedules to match the availability of inpatient beds.
•    Using hospital websites for scheduling ER appointments online. This lets doctors prepare for arriving patients and allows the patient to get up-to-date info on wait times.
•    Opening or working with an existing urgent care centers to treat non-emergency patients.
•    Using two-person teams, an attending physician to talk with the patient and a scribe to who can handle the paperwork.
•    Coordinating the discharge of patients before noon every day, which will help free up more beds.
•    Teaching ER visitors who come in repeatedly for non-urgent or chronic issues how to manage their own care.


Many of these solutions only work if the public is aware of the need to reduce ER overcrowding, preferably before they go to the ER. Some important lessons to teach the public are when an ER trip is necessary, what alternative options are available, and what steps can be taken to ensure a quick visit. Patients should also be encouraged to:


•    Call their primary care physician before heading to the ER. This allows their physician to call the ER with the patient’s medical history and any potential medical issues.
•    Have patients bring their medical records if possible to the ER. This will help shorten the examination time needed by the ER staff.
•    Find out what times during the week the ER is busiest so they can come during the low periods if possible.