Established and Novel Initiatives to Reduce Crowding in Emergency Departments

Introduction: The American College of Emergency Physicians (ACEP) Task Force on Boardingdescribed high-impact initiatives to decrease crowding. Furthermore, some emergencydepartments (EDs) have implemented a novel initiative we term “vertical patient flow,” i.e.segmenting patients who can be safely evaluated, managed, admitted or discharged withoutoccupying a traditional ED room. We sought to determine the degree that ACEP-identified highimpactinitiatives for ED crowding and vertical patient flow have been implemented in academicEDs in the United States (U.S.).Methods: We surveyed the physician leadership of all U.S. academic EDs from March toMay 2010 using a 2-minute online survey. Academic ED was defined by the primary site of anemergency residency program.Results: We had a response rate of 73% (106/145) and a completion rate of 71% (103/145).The most prevalent hospital-based initiative was inpatient discharge coordination (46% [47/103]of respondents) while the least fully initiated was surgical schedule smoothing (11% [11/103]).The most prevalent ED-based initiative was fast track (79% [81/103]) while the least initiated wasphysician triage (12% [12/103]). Vertical patient flow had been implemented in 29% (30/103) ofresponding EDs while an additional 41% (42/103) reported partial/in progress implementation.Conclusion: We found great variability in the extent academic EDs have implemented ACEP’sestablished high-impact ED crowding initiatives, yet most (70%) have adopted to some extentthe novel initiative vertical patient flow. Future studies should examine barriers to implementingthese crowding initiatives and how they affect outcomes such as patient safety, ED throughput andpatient/provider satisfaction.