Utilization and Overcrowding of Hospital Emergency Departments

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Utilization and Overcrowding of Hospital
Emergency Departments

• David Shactman, MPA, MBA
• Senior Research Associate
• Schneider Institute for Health Policy
• January 22, 2002

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Shoot to Kill!
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Take off those sneakers!
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Figure 1 Emergency Department Visits 1992-1999
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Figure 2ED Visits per Thousand Population
Visits/1000 Population
Year
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Figure 3Hospital Unit Inpatient Days
Year
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Figure 4Hospital Unit Inpatient Days per
Thousand Population
Year
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Figure 5Number of Hospital Beds
Year
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Figure 6Hospital Beds per Thousand Population
Hospital Beds/1000 Population
Year
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Figure 7ED Visits per Hospital Bed
Year
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Increased Demand for ED Services - managed care
backlash, increased regulation, reduced
utilization review - availability of PCPs -
non-urgent conditions in ED - complex diagnostic
technology - uninsurance - demographics -
preferences for ED care
Reduced Supply of ED Services - shortage of
on-call specialists - shortage of nurses -
case-mix complexity - more complex technology -
more 1st-time patients due to ambulance
diversions - no community coordination
E.D. SUPPLY
E.D. DEMAND
HOSPITAL E.D.
Discharge Barriers, Operations Management and
Delayed Services - reduced post-acute care -
natural and artificial variability - operational
inefficiencies - information systems - peak hour
overcrowding - bed flexibility - transportation
HOSPITAL DEMAND
HOSPITAL SUPPLY
Reduced Inpatient Supply - shortage of nurses
licensed, operating and staffed beds - type of
bed unavailable - census method inaccurate
Increased Inpatient Demand - managed care
changes - technology and medical capabilities -
demographics - competition and marketing
HOSPITAL INPATIENT
THROUGHPUT DELAYS
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Reducing ED Overcrowding without Building More
Capacity

• I. Increase inpatient supply without major
  construction
• Convert all licensed beds to operating beds
• Staff all beds
• Operate and staff for actual census
• Increase bed flexibility, if possible, while
  maintaining quality

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Reducing ED Overcrowding without Building More
Capacity

• II. Work diligently on throughput
• Improve discharge placement - consider discharge
  holding unit
• Upgrade information systems - computerize
  on-line bed status
• Utilize operation management techniques to
  efficiently utilize and staff ORs
  and ICUs
• Get rid of artificial variability in scheduling
• Work on peak hour overcrowding

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Reducing ED Overcrowding without Building More
Capacity

• III. Reduce Non-Urgent Demand
• Collaborate with primary care docs and Community
  health centers
• Educate Docs and Patients
• Consider charges for non-urgent visits
• Institute follow-up planning for patient visits
  and for monitoring treatment regimens

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Reducing ED Overcrowding without Building More
Capacity

• IV. Increase ED capacity
• Have dedicated space and staff for non-urgent
  care unit
• Increase number of observation beds
• Consider dedicated services (imaging)
• Triage immediately, dont let registration delay
  triage or treatment
• Work with on-call docs