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Quality Improvement Promising Practices from the Field

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Reducing Emergency Department Crowding Through the Full Capacity Protocol

    • June 4, 2008

Intervention Title: Reducing Emergency Department Crowding Through the Full Capacity Protocol – Stony Brook University Hospital; Stony Brook, N.Y.

Goal: Reduce emergency department (ED) crowding and improve patient care, patient safety and patient satisfaction levels.

Innovation: Staff implemented the Full Capacity Protocol, which redistributes admitted patients boarding in the ED to acute-care hallway beds on inpatient units when the ED is unable to evaluate and treat new emergency patients in a timely manner because of a lack of space and resources.

Result: Initiation of the Full Capacity Protocol has led to a substantial increase in patient safety and satisfaction. Of those patients transferred, almost 50 percent were assigned a room immediately or in less than one hour. Additionally, the average length of stay for patients boarded on the acute care floors is almost one day less than the average for similar patients boarded in the ED.

Institution: Stony Brook University Hospital 101 Nicolls Road Stony Brook, NY 11794 P: (631) 444-4000

From the C-Suite:

This innovation helped us reduce ED overcrowding caused by boarding of admitted patients. By utilizing the resources within our entire institution, we identified hallway boarding on inpatient units as a solution superior to boarding in the ED, both from a patient safety and operational perspective. Once implemented, the results have been quite positive. Now not only do our patients receive the care that they need in a timely and improved manner, but admitted patients receive better care in a better setting.

Peter Viccellio, M.D., F.A.C.E.P. Clinical Director of Emergency Medicine

Profile: Stony Brook University Hospital is a 502-bed (32 in the ED) for-profit teaching hospital on Long Island, N.Y.

Clinical areas affected:

  • ED and inpatient units

Staff involved:

  • Hospital bed coordinator
  • Hospital medical director
  • ED staff (nurses, physicians and technicians)
  • Inpatient unit staff (nurses, physicians and technicians)

Timeline: Three-month planning and implementation to change processes

Contact: Peter Vicellio, M.D., F.A.C.E.P. Clinical Director of Emergency Medicine P: (631) 444-3880

Innovation implementation: The ED team at Stony Brook University Hospital faced a dilemma familiar to most hospitals: a large demand for services but limited space and resources to handle it because of the boarding of admitted patients in the ED.

Stony Brook's answer was a Full Capacity Protocol policy—a systemwide policy to better utilize space and staff throughout the hospital rather than allowing admitted patients to accumulate in the ED when the inpatient units lack appropriate beds. Under the new protocol, when the ED is overloaded and has inadequate space to evaluate and treat new patients in a timely fashion, the hospital's bed coordinator and medical directors activate the protocol and transfer admitted patients from the ED to acute care beds located in hallways on inpatient units, with each unit absorbing up to two additional patients over their usual maximal census.

Despite conventional objections to hallway boarding, the hospital firmly believes that placing patients in a safer, more monitored environment that has a higher nurse-to-patient ratio than the ED is a critical component to quality care. Moving patients to quieter, less chaotic surroundings also significantly improves patients' perceptions of their care.

Just as important, the Full Capacity Protocol helped change hospital staff members' view of flow and crowding from being an ED problem to being an institutional problem that required all of their help to solve. The new protocol has improved the turnover of inpatient beds, which allows patients to be moved through the ED faster and ultimately helps decrease boarding patients in the ED or inpatient halls.

Advice and lessons learned:

  1. Explain the facts.
  2. Get senior staff champions

Cost/benefit estimate: The biggest investment in this innovation was the time it took to change hospital policy. The benefits were significantly improved patient care and satisfaction scores, improved safety for boarded patients, and more efficient patient flow throughout the entire system.

All information is current as of June 2008 unless otherwise specified. Please note our Terms of Use.