title: Should you close your waiting room? Addressing ED overcrowding through education and staff-based participatory research.
abstract: BACKGROUND
  The purpose of this project was to develop operational criteria to "close the ED waiting room".
  
  
  METHODS
  A prospective, staff-based participatory research model was used. Nurses at an urban ED with 70,000 visits attended a four-hour workshop concerning ED overcrowding. The workshops consisted of two parts, (1) educational sessions that reviewed key concepts of ED overcrowding, followed by (2) discussions of a proposal to "close the waiting room" as a means to decrease overcrowding. During the discussions, nurses were asked to develop guidelines to safely and consistently "close the waiting room." The investigators defined the waiting room as "closed" when (1) ambulatory patients could be taken directly to a room or hallway space for bedside triage, registration, and initiation of care, or (2) patients were triaged in the waiting room and then taken directly to a care space for registration at the bedside. The primary outcome measure of the project was the development of guidelines to open (use) or close (not use) the ED waiting room.
  
  
  RESULTS
  Seventy three of 100 nurses participated in the workshops. ED waiting room closure criteria were developed as 4 "Questions to Guide the Use of the Waiting Room." These dichotomous (yes/no) questions reflected issues of available staff, available care space (traditional ED bed spaces and designated hall spaces), patient acuity, and additional surge capacity.
  
  
  CONCLUSIONS
  Staff-based participatory research was an effective method to design an operational change. Nurses developed four explicit criteria describing when the waiting room should be closed.
authors.affiliation: Institute for Healthcare Studies, Northwestern University, Chicago, Ill 60611, USA. ptanabe2@nmff.org
authors.forename: Paula
authors.initials: P
authors.lastname: Tanabe
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gisondi
authors.forename: Sara
authors.initials: S
authors.lastname: Medendorp
authors.forename: Laurie
authors.initials: L
authors.lastname: Engeldinger
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Graham
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Lucenti
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D003441:Crowding; D003659:Decision Making, Organizational; D004509:Education, Nursing, Continuing / Q000458:organization & administration; D016529:Emergency Nursing / Q000193:education / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006271:Health Facility Closure / Q000379:methods*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D015402:Nursing Education Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D017751:Safety Management; D013598:Systems Theory; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration; D014218:Triage / Q000458:organization & administration; D014850:Waiting Lists