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Managing capacity to reduce emergency department overcrowding and ambulance diversions. 2006

Deborah A Yancer, and Debra Foshee, and Helen Cole, and Rebecca Beauchamp, and Will de la Pena, and Tom Keefe, and William Smith, and Kathryn Zimmerman, and Marisa Lavine, and Barbara Toops
Shady Grove Adventist Hospital, Rockville, Maryland, USA.

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. CONCLUSIONS 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.

UI MeSH Term Description Entries
D008396 Maryland A state bounded on the north by Pennsylvania, on the east by Delaware and the Atlantic Ocean, on the south by Virginia and West Virginia, and on the west by West Virginia.
D010360 Patient Transfer Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as for the type of care provided. Patient Dumping,Care Transition,Health Care Transition,Patient Transition,Patient Turfing,Transition of Care,Care Transition, Health,Care Transitions,Care Transitions, Health,Dumping, Patient,Health Care Transitions,Patient Transfers,Patient Transitions,Patient Turfings,Transfer, Patient,Transfers, Patient,Transition, Care,Transition, Health Care,Transition, Patient,Transitions, Care,Transitions, Health Care,Transitions, Patient,Turfing, Patient,Turfings, Patient
D003441 Crowding An excessive number of individuals, human or animal, in relation to available space.
D004636 Emergency Service, Hospital Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient. Emergency Outpatient Unit,Emergency Services Utilization,Hospital Emergency Room,Hospital Emergency Service,Hospital Emergency Services Utilization,Accident and Emergency Department,Emergency Departments,Emergency Hospital Service,Emergency Room,Emergency Units,Emergency Ward,Hospital Service Emergency,Service, Hospital Emergency,Department, Emergency,Departments, Emergency,Emergencies, Hospital Service,Emergency Department,Emergency Hospital Services,Emergency Outpatient Units,Emergency Room, Hospital,Emergency Rooms,Emergency Rooms, Hospital,Emergency Services, Hospital,Emergency Unit,Emergency Wards,Emergency, Hospital Service,Hospital Emergency Rooms,Hospital Emergency Services,Hospital Service Emergencies,Hospital Service, Emergency,Hospital Services, Emergency,Outpatient Unit, Emergency,Outpatient Units, Emergency,Room, Emergency,Room, Hospital Emergency,Rooms, Emergency,Rooms, Hospital Emergency,Service Emergencies, Hospital,Service Emergency, Hospital,Service, Emergency Hospital,Services Utilization, Emergency,Services Utilizations, Emergency,Services, Emergency Hospital,Services, Hospital Emergency,Unit, Emergency,Unit, Emergency Outpatient,Units, Emergency,Units, Emergency Outpatient,Utilization, Emergency Services,Ward, Emergency,Wards, Emergency
D006788 Hospitals, Voluntary Private, not-for-profit hospitals that are autonomous, self-established, and self-supported. Hospitals, Private, Not-for-Profit,Hospitals Privates, Not-for-Profit,Not-for-Profit Hospitals Private,Not-for-Profit Hospitals Privates,Private, Not-for-Profit Hospitals,Voluntary Hospitals,Hospital, Voluntary,Hospitals Private, Not-for-Profit,Hospitals Privates, Not for Profit,Not for Profit Hospitals Private,Not for Profit Hospitals Privates,Private, Not for Profit Hospitals,Privates, Not-for-Profit Hospitals,Voluntary Hospital
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000552 Ambulances A vehicle equipped for transporting patients in need of emergency care. Emergency Mobile Units,Mobile Emergency Units,Ambulance,Emergency Mobile Unit,Emergency Unit, Mobile,Emergency Units, Mobile,Mobile Emergency Unit,Mobile Unit, Emergency,Mobile Units, Emergency,Unit, Emergency Mobile,Unit, Mobile Emergency,Units, Emergency Mobile,Units, Mobile Emergency
D001363 Awards and Prizes Awards,Prizes,Award,Prize,Prizes and Awards
D017598 Efficiency, Organizational The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, material, etc. Efficiency, Administrative,Productivity, Organizational,Program Efficiency,Administrative Efficiency,Organizational Productivity,Efficiency, Program,Organizational Efficiency,Program Efficiencies
D019982 Organizational Case Studies Descriptions and evaluations of specific health care organizations. Case Studies, Organizational,Management Case Studies,Case Studies, Management,Studies, Management Case,Studies, Organizational Case

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