Improving wait times in high volume ERs

[Lev, MSN, RN, NP]

What has your ER done to improve wait times?

I work in a ~400 bed community teaching hospital with an ER that sees over 100K patients a year. I work on the adult side. We have 46 main ER rooms, 10 ED observation beds, and 8 fast track rooms. We will use the obs rooms as fast track if there aren't enough obs patients.

The hospital has an overflow unit without telemetry capabilities that is not usually staffed. Most of our boarders are telemetry patients.

We frequently have ~20 boarders each shift. Since the storm on the east coast I have come into my shift with ~60 people in the waiting room.

The fast track rooms are not staffed with a doctor all night and PAs can only see 4s and 5s without a doctor.

These are the problems.

[Lunah, MSN, RN]

We all know that the bottleneck is usually getting the inpatient beds — the boarders consume resources that should be given to newly presenting patients. I wrote a paper about NEDOCS and surge capacities, and I found that when you make ED overcrowding a hospital problem vs. just an ED problem, that helps. Depending on the capacity levels, having processes in place such as having inpatient boarders in floor hall beds or sending notifications to administration (who should care, in theory) that the ED has exceeded capacity can help decompress the ED. But the problem has to be treated as a system problem, not just something that the ED has to deal with.

[Lev, MSN, RN, NP]

We all know that the bottleneck is usually getting the inpatient beds — the boarders consume resources that should be given to newly presenting patients. I wrote a paper about NEDOCS and surge capacities, and I found that when you make ED overcrowding a hospital problem vs. just an ED problem, that helps. Depending on the capacity levels, having processes in place such as having inpatient boarders in floor hall beds or sending notifications to administration (who should care, in theory) that the ED has exceeded capacity can help decompress the ED. But the problem has to be treated as a system problem, not just something that the ED has to deal with.

The problem is that many of these patients are tele patients who cant be monitored in the hall. We could put them on tele boxes but the monitor is set up that only one/four sections of the ed can see the tele box rythmns. The tele boxes are meant to be for patients going off the unit who need tele but not rn transport. We have many times have people who board for 12 hrs or more. Can we keep them in the hallway for that long? We will put patients who are waiting for transport in the hallway even those on tele at times if stable.

I think you are right about treating this as a system problem. The hospital needs to get the overflow unit tele capabilities and get some float staff to staff the unit. The issue I can see is that the overflow unit is in the "older" part of the hospital, so they may not want to invest in it.