Crowding, Boarding, and Patient Throughput Position Statement-Crowding, Boarding, And Patient Throughput Position Statement

Pdf Summary

Emergency department crowding is a global problem that occurs when the demand for services exceeds the resources available in the department. It is associated with negative patient outcomes such as increased mortality, medical errors, and delays in care. Crowding also leads to decreased patient satisfaction and increased rates of patients leaving without being seen. It has a negative impact on nursing workload and staff turnover. Additionally, crowding affects the Emergency Medical Services system, leading to ambulance diversion and patient offload delay.<br /><br />Patient boarding, which refers to holding an admitted patient in the ED while waiting for an inpatient bed, is a common issue in tracking and understanding the problem. There are discrepancies in the definition of patient boarding, leading to inconsistent tracking. The decision-to-admit varies across hospitals, adding to the complexity. The Emergency Medical Treatment and Active Labor Act states that boarding cannot begin until the patient has received emergency stabilization, completed diagnostic studies, and had a handoff or transfer order.<br /><br />Patient throughput, which involves the arrival, care, and departure of patients in the ED, is a foundational concept in understanding and addressing crowding. It helps identify how one source of crowding impacts another and emphasizes the need for a hospital-wide systems approach.<br /><br />To address crowding, hospitals should use staffing calculations that account for extended care times during crowding, boarding, and/or throughput delay. The wHPPV (worked hours per patient visit) method with a buffer is recommended to capture actual labor productivity and determine additional staffing needs.<br /><br />It is crucial to have consistent data and measurement to understand and address factors contributing to ED crowding. Multidisciplinary collaboration between the ED and inpatient areas is essential in addressing patient boarding. Quality improvement teams should be implemented to improve patient throughput and outcomes.<br /><br />Further research is needed to identify best practices for calculating labor productivity during crowding, boarding, and/or throughput delay.

Meta Tag

crowding errors

crowding staffing

crowding burnout

crowding turnover

crowding patient flow

crowding admission

crowding EMTALA

crowding hospital

crowding system

crowding extended hours

crowding visits

Keywords

Emergency department crowding

negative patient outcomes

patient satisfaction

nursing workload

staff turnover

patient boarding

patient throughput

hospital-wide systems approach

staffing calculations

labor productivity