From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

Abstract

Background: Our Emergency Department (ED) went through two periods with different managers. Although the number of beds, visits and admissions during these two periods didn't change significantly, a change in the ED’s policy, without a change in the hospital’s policy, converted a very crowded ED to an uncrowded one within few weeks, and changed the pattern of work in the hospital, gradually for many years. Objectives: To share our experience and describe how a very crowded ED was transformed into an uncrowded one within few weeks and how we maintained the change thereafter. Methods: All data concerning the ED and other department activities were collected by using our hospital’s computerized business intelligence (BI) system. Results: The average length of stay (LOS) of admitted patients in the ED was 5.05+0.98 hrs during period "A" (1993-2001). It dropped to 2.45+0.21 during period "B" (2002-2007) (P<0.001). The percent of patients boarding in the ED more than 10 hours dropped from 11.5+2.4% (period “A”) to 2.6+0.7% (period “B”) within three months. Despite a gradual increase in the number of admissions to the GM wards, there was a gradual decrease in the average LOS during period "B", compared to period "A" (6.1 vs. 5.5 days) (P=0.001). The death rate among patients in the ED and in the GM wards decreased significantly during period "B" (P<0.001). Conclusions: We were able to achieve a difficult goal of eliminating overcrowding in the ED and consequently, other hospital’s wards only through assertiveness, persistence, adherence to protocols and the full personal backing of the hospital's manager.