Emergent Care; Safety Net; Hospitals
This report profiles five safety-net hospitals—Boston Medical Center, Denver Health, Memorial Regional Hospital, Memorial Hospital West, and Virginia Commonwealth University Health System—that made improvements to curb emergency department (ED) crowding, reduce long waits, and lower the number of hours spent on ambulance diversion. Hospitals used a combination of interventions, including: reconfiguring the ED to maximize efficiency; devising a pre-diversion system to alert staff of ED crowding; installing an electronic tracking system; designating staff members to be responsible for tracking patients; and developing meaningful performance metrics. To be successful, such interventions need to take place within a broader improvement strategy that entails: recognition that ED crowding is a hospital-wide issue; leadership provided by the CEO and other senior staff; vigilance in pursuing change, reviewing outcomes, and working to improve; transparency; and a commitment to quality for safety-net populations.
Nolan, L., Regenstein, M., Anthony, D., & Siegel, B. (2009). Emergency department operations in top-performing safety-net hospitals (Commonwealth Fund pub. no. 1305). Washington, D.C.: Commonwealth Fund.