title: The Most Crowded US Hospital Emergency Departments Did Not Adopt Effective Interventions To Improve Flow, 2007-10.
abstract: Emergency department (ED) crowding adversely affects patient care and outcomes. Despite national recommendations to address crowding, it persists in most US EDs today. Using nationally representative data, we evaluated the use of interventions to address crowding in US hospitals in the period 2007-10. We examined the relationship between crowding within an ED itself, measured as longer ED lengths-of-stay, and the number of interventions adopted. In our study period the average number of interventions adopted increased from 5.2 to 6.6, and seven of the seventeen studied interventions saw a significant increase in adoption. In general, more crowded EDs adopted greater numbers of interventions than less crowded EDs. However, in the most crowded quartile of EDs, a large proportion had not adopted effective interventions: 19 percent did not use bedside registration, and 94 percent did not use surgical schedule smoothing. Thus, while adoption of strategies to reduce ED crowding is increasing, many of the nation's most crowded EDs have not adopted proven interventions.
authors.affiliation: Leah S. Honigman Warner (lwarner2@nshs.edu) is an attending physician in the Department of Emergency Medicine at Long Island Jewish Medical Center, in New Hyde Park, New York. At the time this research was completed, she was an attending physician in the Department of Emergency Medicine at the George Washington University, in Washington, D.C.
authors.forename: Leah S Honigman
authors.initials: LS
authors.lastname: Warner
authors.affiliation: Jesse M. Pines is director of the Office for Clinical Practice Innovation, School of Medicine and Health Sciences, and a professor of emergency medicine and health policy, both at the George Washington University.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.affiliation: Jennifer Gibson Chambers is a resident in emergency medicine at Albany Medical College, in New York.
authors.forename: Jennifer Gibson
authors.initials: JG
authors.lastname: Chambers
authors.affiliation: Jeremiah D. Schuur is an attending physician; chief of the Division of Health Policy Translation; and director of quality, patient safety, and performance improvement, all in the Department of Emergency Medicine, Brigham and Women's Hospital, in Boston, Massachusetts. He is also an assistant professor of emergency medicine at Harvard Medical School.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
mesh_terms: D003441:Crowding; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational / Q000639:trends*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D010360:Patient Transfer / Q000706:statistics & numerical data; D014481:United States
keywords: Hospitals; Organization and Delivery of Care; Quality Of Care; Safety-Net Systems