ED Boarding Plan Emergency Department Overcrowding Due

ED Boarding Plan

Emergency Department Overcrowding Due to Boarding: Proposed Solution

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

A. Form an interdisciplinary committee of nurse, medical, and support staff to assess the impact of emergency department boarding

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 practices and policies of the solution remain firmly in place, and to determine the level of efficacy that this program is having in regards to patient outcomes and the efficiency and cost-effectiveness of the emergency department and the institution as a whole. Such evaluation programs have already been implemented in other institutions that have adopted the same change in practice and policy as part of ongoing research in the matter, and other research can help support the creation of more comprehensive evaluations (Viccellio et al. 2009; Garson et al. 2008). Patient outcome records for those admitted to the hospital can easily be compared to outcomes from patient populations previously admitted to the emergency department itself to determine the quality of care and change in outcome that has been achieved, and costs can be monitored on both a per-patient basis and as an absolute measure to determine if changes are occurring in efficiency and cost-effectiveness as expected.

The resources that will be needed for this evaluation are minimal, and in fact much of the data that will be necessary part of the analysis and evaluation of this program will almost certainly already be collected and assessed by hospital administration for costing and pricing purposes as well as to rank relative medical standings and care outcomes. That is, the improvements that are expected from the change in practice will likely be measurable in the already-recorded and maintained statistics of the hospital's day-to-day operations. It might be necessary for time to be spent on the specific determinations relevant to the change in practice and the collation of data retrieved through these methods, but no equipment other than a hospital computer connected to the relevant databases (and appropriate authorization to access these databases) will be necessary for carrying out this evaluation.