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Quality Improvement Promising Practices from the Field

An RWJF Collection

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Urgent Matters Program Toolkit

Proven Solutions to ED Crowding

    • March 3, 2010

Across America, hospital emergency departments (EDs) are in crisis. For many communities, the local hospital ED has become the linchpin of their health care safety net. With a legal obligation to see patients at all times and with more people than ever seeking their services, EDs nationwide are bursting at the seams.

The Urgent Matters program, a national initiative of the Robert Wood Johnson Foundation managed by The George Washington University Medical Center School of Public Health and Health Services, Department of Health Policy, has worked intensively to try to find solutions to the problems of poor patient flow and overcrowded EDs that could be applicable nationwide.

As part of the program, 16 hospitals have participate in two Learning Networks aimed at developing a series of practical management tools to address issues related to ED overcrowding. As the initiative evolved, hospitals participating in the Learning Networks worked together to identify, test and implement strategies for improving patient flow and reduce ED crowding, and in the process created their own best practices.

The Urgent Matters team identified the most innovative patient flow quality improvement strategies implemented by participating pilot hospitals and maintains this unique web-based toolkit capturing the strategies designed for hospital use in an easy-to-read and implement format.

This toolkit currently contains 55 strategies with 95 associated tools. Each strategy includes information on the hospital where the strategy was piloted, associated tools, and a description of the strategy implementation and outcomes. Strategies are organized into five categories:

  • Input,
  • Throughput,
  • Output,
  • Communications/Information Technology (IT), and
  • Scheduling/Staffing.

In an era when hospitals nationwide are being forced to do more with less, many factors contribute to crowded EDs—at times forcing facilities to go on bypass or diversion. While many of these factors are outside of a hospital’s control, others can be influences through staff’s and management’s focus on patient flow across the hospital. Many of the strategies in this toolkit are critical resources that hospitals can learn from to decompress their EDs and improve patient flow.