Improving Service Quality by Understanding Emergency Department Flow: A White Paper and Position Statement Prepared For the American Academy of Emergency Medicine

Overcrowding in the Emergency Department and Patient Safety

“…ED overcrowding also occurs when patients intended for discharge (as well as those for admission) from the ED remain in the ED for longer than necessary. This may occur secondary to delays in contact or input from consulting services, delays to imaging or specialist interpretation of tests, delays to laboratory results, technological failures, or delays in transportation back to a care facility [4][5][6][7]13]. ED throughput processes contribute to overcrowding through ineicient registration and triage processes, laboratory and radiograph turnaround times, clerical and technologist support, inadequate nursing and physician staing, and delays to decision-making [6,7,20].…”

“…Although there is no true consensus deinition, the best descriptions take into account both the nature of the problem and its outcomes. Overcrowding is not merely a mater of an ED not having adequate resources for the demand placed upon it by the patients or community, it is a supply/demand imbalance in health care needs that results in undesirable outcomes for patients [6,7] …”

Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit

“…Problems with patient-flow in hospital systems have been well described in emergency departments [1][2][3] and acute care hospitals, [4][5][6] and the challenge of managing the increase in demand for hospital services is recognised as a major issue worldwide. It is anticipated that as a result of fiscal constraints in health-care funding and population ageing 7 resulting in an associated increase in chronic disease and disability, the challenge of managing the demand for hospital services will become even more arduous in the coming decades.…”

Clinical Scoring Systems in the Management of Suspected Appendicitis in Children

“…A number of studies have demonstrated practice variation, as well as the impact of variation on clinical outcome measures (Chang, Ng, Y.-C. Chen, J.-C. Chen, & Yen, 2010) (Goldman et al, 2009) (Plint et al, 2004) (Richer et al, 2010) (Jain, Elon, Johnson, Frank, & Deguzman, 2010). While practice variation results in patient outcome differences, standardization of practice based on the best evidence can result in improved care (Eitel, Rudkin, Malvehy, Killeen, & Pines, 2010). Numerous studies have demonstrated the efficacy of Evidence Based Clinical Algorithms (EBCA) such as pathways and protocols in reducing delays in time-sensitive medication administration, reducing unwarranted radiation exposure and reducing mortality (Rivers et al, 2001) (Francis 2010, Osmond 2010.…”