Title

Enhancing work flow to reduce crowding

Document Type

Journal Article

Publication Date

11-2007

Journal

Joint Commission Journal on Quality and Patient Safety

Volume

Volume 33, Issue 11 (suppl. 1)

Inclusive Pages

57-67

Keywords

Efficiency, Organizational; Emergency Service, Hospital--organization & administration; Hospital Administration; Quality of Health Care--organization & administration; Work Simplification; Quality Improvement

Abstract

INTRODUCTION: Approximately one third of hospitals in the United States report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the emergency department (ED). In a recent national survey, 40% of hospital leaders viewed ED crowding as a symptom of workforce shortages. Many health systems are implementing a variety of strategies to improve flow and reduce crowding.

DOMAINS OF IMPROVEMENT: Virtually all work-flow initiatives use operations management techniques that include some or all of four domains: performance measurement, demand forecasting, flow redesign, and capacity management. These are often implemented using rapid improvement techniques. Most initiatives tend to focus on functional increases in inpatient capacity.

IMPLICATIONS FOR PRACTICE AND POLICY: Successful strategies to improve patient flow are distinguished by an organizationwide commitment to measurement, transparency in data reporting, and sustained management attention. Focusing on transitions between ED and inpatient units and maximizing overall hospital capacity appears necessary for improvement. Hence, reductions in ED crowding require strategies that go far beyond the ED.

CONCLUSION: Health systems can take tangible, immediate steps to improve flow and reduce crowding. Efforts would be enhanced by more controlled trials of existing strategies in the context of uniform performance measures.

Peer Reviewed

1