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ED Boarding Plan
Emergency Department Overcrowding Due to Boarding: Proposed Solution Form an interdisciplinary committee of nurse, medical, and support staff to assess the impact of emergency department boarding
The proposed solution for the noted problem of emergency department overcrowding due to the practice of boarding patients in the emergency department rather than admitting them to other areas of the hospital is relatively simple and straightforward. In essence, the solution that is most supported by current research is to simply cease the practice of inpatient boarding in the emergency department, increasing throughput by stabilizing and admitting to other departments those patients that cannot be treated on an outpatient basis, and increasing the number of beds and staff available in other departments to meet this shift (Garson et al. 2008; Viccellio et al. 2009). This solution has been found to be beneficial to medical staff and patients alike, and simply increasing the amount of beds and staffing that exists in the emergency department does not have a similar effect (Walsh et al. 2008; Viccellio et al. 2009). Instead of trying to create the capacity for boarding in a department that was not designed for long-term care and that cannot split its focus between emergency and long-term interventions and achieve equal efficacy with both. This solution restores the hospital and its departments to their intended division of functionality.
There are, of course complications and potential barriers to the effective implementation of this plan, and thus the proposed solution will grow in complexity and specificity as it is implemented. The following pages provide some overview of expected complications and expected solutions. A method for evaluating the solution after implementation is also discussed.
Implementation Plan: Outline
Step One: Educate
A. Inform nursing staff and leadership about current evidence regarding best practices; provide literature
B. Inform medical and support staff and leadership about current evidence regarding best practices; provide literature
C. Inform administrative staff and leadership about current evidence regarding best practices; provide literature
Step Two: Research
B. Discuss and clarify findings regarding this impact; with specific attention to care outcomes and efficiency/cost-effectiveness
C. Determine necessary changes in other departments to accommodate a cessation of boarding practices in the ED and the feasibility of these changes
Step Three: Lobby for Change
A. Have an interdisciplinary leadership team from the committee present findings to appropriate administrators and other relevant leadership individuals not involved in the committee
B. Discuss potential problems that arise form these meetings and seek solutions in the literature and in the institution/individual departments
C. Negotiate commitment to a pilot study based on evidence in the literature and proposed solutions to identified problems
Step Four: Pilot Study
A. Determine time period in which to conduct study with administration, and implement the no-boarding policy for this entire period without exception
B. Evaluate changes in care outcomes, ED throughput, and workload in intensive
care and other departments as the changes take effect
C. Perform analysis following the completion of the pilot period to determine appreciable change
D. Discuss outcomes and experiences with all relevant personnel and collate findings for easy analysis and communication to administration
Step Five: Presentation and Final Implementation
A. Present findings and results of the pilot study to administration
B. If properly implemented, research suggests positive changes in patient outcome, work experience, efficiency, and cost-effectiveness will be visible
C. Permanent adoption (with ongoing evaluation) of the changes implemented should be approved by administration
Evaluation Plan
After the proposed solution has been implemented on a full-time basis, an ongoing system of evaluation must be put into place both to ensure that the specific…
references for Boarding Locations When Hospitals Are at Full Capacity. Annals of Emergency Medicine 51(1): 9-12.
Viccellio, A., Santora, C., Singer, A., Thode, H. & Henry, M. (2009). The Association Between Transfer of Emergency Department Boarders to Inpatient Hallways and Mortality: A 4-Year Experience. Annals of Emergency Medicine 54(4): 487-91.
Walsh, P., Cortez, V. & Bhakta, H. (2008). Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed. The Journal of Emergency Medicine 34(2): 221-6.
2010; McCarthy et al. 2009; Zimmerman 2004). These studies have also shown that a reduction in boarding numbers and crowding can eliminate or reduce these problems. After all of these considerations, the fourth step in Rosswurm and Larrabee's (1999) model for change is to design the actual changes to practice that should be implemented. In this case, this requires few additional resources other than learning materials for hospital staff to
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Hiring a Nurse Practitioner reduces wait times (overcrowding) in the Emergency Department estimation of the ED (Emergency department) compromise with care afforded to patients because of overcrowding from the perspective of the provider of services. /I researched literature and bonafide / authenticated texts that chose to: Study causation, impacts and resolution tactics aimed at ED crowding; Collected and analyzed data using established methods; specifically target the ED scenario and the day-to-day crowding
ED Patient Boarding | Emergency Department Patient Boarding Emergency Department (ED) crowding is a nationwide crisis which affects the efficiency and the quality of patient care (Sox, Burstin, Orav, et al., 2007). A huge contribution to patient over-crowding is the boarding of admitted patients in the ED. An alternative use of time which is lost in the admitting of patients is used to treat patients who are waiting to be seen; this