title: Hospital addresses ED overcrowding, sees treatment times and walkout rates drop.
abstract: Mary Washington Hospital in Fredericksburg, VA, addressed the new accreditation standard on overcrowding and saw its treatment times drop by about two hours and its walkout rate drop to 2%, despite increases in volume. A Patient Flow Excellence and Accountability Team focused on getting patients upstairs in under one hour, which was achieved through nurse and supervisor buy-in. Monthly staff meetings were added for all shifts. Computers and equipment for trauma and codes were placed closer to where they were needed. The staffing ratio on the acute side was reduced to 1:4 for nurses and 1:12 for physicians. The ED converted to a five-level triage system, and the hospital is experimenting with a triage nurse focused on lower acuity areas and a "virtual bed system" in which patients are seen by a physician/nurse team at triage and start having labs and X-rays done immediately.
mesh_terms: D003441:Crowding; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D019982:Organizational Case Studies; D014768:Virginia