title: A new strategy for emergency department crowding: High-turnover utility bed intervention.
abstract: BACKGROUND
  This study applied a new strategy, termed high-turnover utility bed intervention, to offer early admission chances for emergency department (ED) patients and alleviate ED crowding.
  
  
  METHODS
  This before-and-after observational cohort study was conducted at the ED of an urban tertiary hospital. On January 1, 2012, 14 utility beds were prepared exclusively for ED patient use. A strict 48-hour course limit for each patient was formulated to govern these high-turnover beds. The primary outcome measure for this study was ED length of stay. Secondary outcome measures were the number of ED admissions, patients who left without being seen, and revisits within 72 hours of discharge, as well as the outcomes of cardiac arrest management and ambulance diversion hours.
  
  
  RESULTS
  There were 70,515 adult ED visits enrolled during the preintervention period (January-December 2011), and 69,706 during the postintervention period (July 2012-June 2013). In the postintervention period, this new strategy offered 1401 early admission opportunities. The ambulance diversion hours decreased prominently from 5.4 hours to 1.6 hours per day. A shortening in ED length of stay from 9.7 hours to 8.0 hours was achieved, mainly in cases of nontrauma. More patients (31.2% vs. 29.7%) were admitted to the wards with a lower discharge rate in the postintervention period. Additionally, there was no difference in ED revisit within 72 hours and cardiac arrest management.
  
  
  CONCLUSIONS
  The high-turnover ED utility bed intervention offered improved admission chance and alleviated ED crowding output. ED efficiency improved, with shortened ED length of stay and fewer ambulance diversion hours.
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Biomedical Informatics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: I-Hsin
authors.initials: IH
authors.lastname: Lee
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Chung-Ting
authors.initials: CT
authors.lastname: Chen
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Yi-Tzu
authors.initials: YT
authors.lastname: Lee
authors.affiliation: Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yueh-Shuang
authors.initials: YS
authors.lastname: Hsu
authors.affiliation: Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Lu
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Hsien-Hao
authors.initials: HH
authors.lastname: Huang
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Teh-Fu
authors.initials: TF
authors.lastname: Hsu
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: ckhow@vghtpe.gov.tw.
authors.forename: Chorng-Kuang
authors.initials: CK
authors.lastname: How
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.affiliation: Institute of Biomedical Informatics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Ueng-Cheng
authors.initials: UC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003441:Crowding; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged
keywords: ambulance diversion; crowding; emergency department; length of stay; turnover rate