What is the evidence-based approach to managing emergency room overcrowding at John Hopkins (Johns Hopkins Hospital)?

From the Guidelines

Johns Hopkins should prioritize the implementation of a capacity command center with real-time dashboards to monitor ED status and coordinate hospital-wide resources, as this approach has been shown to improve patient flow and resource allocation in emergency room overcrowding situations. This strategy is supported by the most recent and highest quality study available, which highlights the importance of effective load-balancing and resource management in mitigating crisis care situations 1.

Key Strategies for Addressing Emergency Room Overcrowding

• Implementing a front-end rapid triage system to quickly identify high-acuity patients
• Utilizing a fast-track system for lower-acuity cases that can be treated efficiently
• Creating observation units for patients requiring extended monitoring but not full admission
• Adopting team-based care models where physicians and nurses work collaboratively on patient cases
• Employing predictive analytics to anticipate surge periods and staff accordingly

The success of these strategies stems from a system-wide perspective that recognizes ED crowding as a hospital-wide issue requiring coordinated solutions across departments. By prioritizing the implementation of a capacity command center and other evidence-based strategies, Johns Hopkins can improve patient flow, reduce wait times, and enhance patient satisfaction while minimizing the number of patients who leave without being seen. Effective load-balancing and resource management are critical in mitigating crisis care situations, and regional mechanisms to share information and load-balance across facilities may be the most important factor in achieving this goal 1.

Importance of Inpatient Occupancy and Bed Availability

• High hospital occupancy directly correlates with longer length of stay for all patients treated in the ED
• Inpatient occupancy rates above 80% of capacity are associated with increased odds of patients leaving without being seen or being treated in a hallway bed
• The development of an early alert system for housewide awareness of reduced bed availability is key to ensuring that all stakeholders can immediately be made aware when inpatient beds become scarce or are no longer available 1.

By addressing these factors and implementing evidence-based strategies, Johns Hopkins can effectively mitigate emergency room overcrowding and improve patient outcomes. The use of real-time dashboards and predictive analytics can help anticipate and prepare for surge periods, reducing the strain on ED resources and improving the overall quality of care.

From the Research

Emergency Room Overcrowding: Evidence from John Hopkins

• Emergency department overcrowding is a common and worldwide phenomenon, widely reported in the lay press, with strategies to address this situation urgently needed 2.
• Overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care since 1980, with the COVID-19 pandemic contributing to its accentuation 3.
• The problem of overcrowding in emergency departments occurs due to a disproportion between user demand and the physical, human, and structural resources available 4.

Strategies to Manage Overcrowding

• Proposed strategies to manage overcrowding include improving patient flow, delaying services provided, and overcrowding of emergency departments 4.
• Solutions can be grouped into five categories: work organization, investment in primary care, creation of new dedicated professional figures, work and structural modifications, and implementation of predictive simulation models using mathematical algorithms 4.
• Effective measures to guarantee an improvement in patient flow include improving the efficiency of human resources and developing predictive mathematical models, regardless of the type of hospital and its location 4.

Interventions to Solve Overcrowding

• Interventions to solve overcrowding can be grouped into four categories: strengthening of the triage service, strengthening of the ED's team, creation of new care zones, and change in ED's work processes 5.
• The implementation of full capacity protocol (FCP) is an internationally recognized intervention designed to address emergency department crowding, with core components including collaboration with inpatient nursing staff, reaching consensus about the criteria for activation of each FCP level, and modifying the electronic health records system 6.
• Successful FCP implementation requires a supportive and cooperative hospital culture, with key stakeholders acknowledging that crowding is a hospital-wide problem that requires a hospital-wide response 6.