Tuesday, March 4, 2008 was yet another busy day in the MRMC ED. Volume and admissions exceeded expectations and there were a handful of in-patients awaiting beds upstairs (including those destined for the ICU). The term “ED Overcrowding” was easily defined, simply by walking through the department on that day.
As challenging, and common as these days can be, both in Flint and around the nation, it was a perfect day for our colleagues from the Michigan Hospital Association (MHA) to observe the effects inpatient boarding and crowding have on daily ED operations.
McLaren Regional Medical Center’s ED was chosen (as were four other Michigan EDs) by the MHA to be observed for a “real time” picture of overcrowding, inpatient boarding, and all the associated challenges which develop when hospital demand exceeds supply.
Sam Watson, MSA, who is the executive director of the MHA Keystone Center, was joined by colleagues Kimberly Haught, RN and Morgan Martin, MSA. Their goal was to observe ED operations focused around the effect ED overcrowding/inpatient holders have on ED patient safety and access for patients requiring acute emergency care. Though it goes without saying, all patient confidentiality protocols were strictly followed. Although no hard data was requested or recorded, the team’s overall task was to observe real time what happens to patient throughput times when the ED is overcrowded.
Our colleagues from the MHA were greeted by our CEO Don Kooy, vice president of nursing Joan Maten, and director of critical care nursing Deb Main. After a brief reception, the MHA team wasted no time and immediately integrated themselves into ED operations: Haught and Martin shadowed nurses at triage and at the bedside of not only ED patients, but of inpatient holders (including a ventilated patient). Watson shadowed me, as I cared for ED patients and addressed the occasional medical concerns of inpatients awaiting a bed upstairs. Watson also witnessed first hand the time required by ED staff to explain to patients and their families as to the reasons delays were being encountered both on the front and back end of their stay. The team showed great interest, asked relevant questions, and after about 3 hours our time together ended and a brief discussion and reiteration of the key points occurred. I was impressed with the baseline operational knowledge of our colleagues and their overall sense of understanding the challenges created when admitted patients cannot get upstairs in a timely fashion (i.e. once a facility’s capacity has been exceeded).
Shortly after concluding observational time in the ED, the MHA team followed nursing leadership to several “transitional areas” created by MRMC to address overcrowding and boarding challenges. McLaren renovated several areas for the sole purpose of moving admitted ED patients outof the ED, so operations can continue and ED diversions can be avoided. Clearly, increasing inpatient capacity in any form contributes to patient safety and improves quality of care for the entire institution. The MHA applauded the work done by MRMC leadership.
Though there remains much work to be done on all fronts on these challenging
issues, the MHA and Keystone group remain very proactive and committed in their
approach. Visiting EDs and reviewing peer reviewed ED literature are their first
steps in attempting to understand exactly where the problems reside. After
visiting several more Michigan EDs in the near future, the MHA will begin its
next step in addressing ED overcrowding (similar to its work with the Keystone
ICU project) and begin developing ideas and suggestions aimed at assisting
hospitals and EDs with these daily challenges — all in the name of patient
safety and maintaining ED access.
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