Improving Safety and Quality With an Emergency Department Overcrowding Plan.

INTRODUCTION: Emergency department overcrowding is a concern that predates the recent coronavirus disease pandemic. Overcrowding in the emergency department continues to worsen internationally. There are multiple combined strategies that help to maintain quality and safety by reducing patient wait times, left-without-being-seen rates, and the length of time a patient stays in the emergency department. The objective of the project was to use an interdisciplinary team to strengthen and revise the emergency department overcrowding plan to reduce the patient wait times, length of stay, and the left-without-being-seen rates.

METHODS: The quality improvement team used interprofessional collaboration to focus on 3 areas of the emergency response plan. The team automated an instrument to measure overcrowding in the emergency department, developed a tiered response plan to overcrowding, and implemented a standardized multidisciplinary paging protocol.

RESULTS: The emergency department overcrowding plan resulted in a 2.7% decrease in the left-without-being-seen rates, a 42-minute (14.5%) decrease in median emergency department length of stay, and a 3.56-hour (33.3%) decrease in daily overcrowding.

DISCUSSION: Emergency department overcrowding is influenced by a multitude of factors. The development and implementation of an efficient and effective overcrowding plan have significant value for patient quality and safety as well as health system planning. An effective response to emergency department overcrowding is a pre-established plan that incrementally uses system-wide resources to support emergency department functions as the census and patient acuity fluctuate.