To reduce ER overcrowding, think outside the box

Treatment areas with recliners and community health workers to help guide patients are just two of several creative methods highlighted by Kaiser Health News that various hospitals around the nation are using to stem emergency room overcrowding, a problem that likely will increase as more patients gain health coverage through reform. 

At Ochsner Medical Center in New Orleans, for example, ED patients with non-life threatening ailments are triaged through what the hospital calls its "QTrack," which reserves traditional beds for only the sickest patients. Those whose needs are less urgent instead are seen in patient areas with recliners or procedure rooms, depending on the severity of their symptoms. 

"I was absolutely amazed," Katherine Foley, a patient at Ochsner, told KHN. After suffering a broken wrist, Foley went to Ochsner for her treatment which, despite X-rays, a soft cast and discharge instructions, lasted only about an hour. "I thought it would be five or six hours--two hours to get in, another few to get out." 

Washington, D.C.-based Providence Hospital, meanwhile, recruited community health workers to help guide patients in the right direction for treatment. Despite success--KHN points out that return visits decreased at the facility--ultimately a lack of funding forced the hospital to pull the plug on the program, which had been supported by a year-long grant. 

A more passive-aggressive method to reducing crowding at Long Island's Stony Brook University Medical Center, involves sending patients who need to be admitted to their floors on gurneys, regardless of whether or not beds actually are available. As such patients begin to crowd the non-ED hallways, staff increase their efforts to provide quicker treatment. 

"It's like a fire alarm that goes on at the institutional level," Dr. Peter Viccellio, Stony Brook's clinical director of emergency medicine, told KHN. "Everyone knows there's a problem in the emergency department, we're at capacity." 

Such situations, according to emergency care doctor Art Kellerman--also a Rand Corp. scholar--signify poor management. Dr. Joseph Crane, of Fredericksburg, Va.-based Mary Washington Hospital, disagrees. "It all depends on where you create bottlenecks," Crane told KHN. "It doesn't make sense to point fingers." 

Still, for patients that do end up having to suffer through long waits, one of the better methods for being seen is being persistent--and not leaving, reports CNN

"People often get angry or leave, but that's a bad idea," Dr. Sandra Schneider, president of the American College of Emergency Physicians, told CNN. "If you were sick enough to be there in the first place, then you'll need to wait. 

"As you are waiting [though], if you notice changes in the patient, let the nurses know there is a new symptom as soon as possible." 

To learn more:
- read the Kaiser Health News article
- check out this CNN piece

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