Extended-Care Unit Reduces ED Overcrowding

By opening a 14-bed acute care unit, where emergency patients can be managed for up to 72 hours before being discharged or formally admitted to the hospital, researchers at Johns Hopkins Medical Institutions (Baltimore, MD, USA) have reduced overcrowding in the emergency department (ED) and increased patient satisfaction. The results were reported in the November 2001 issue of Academic Emergency Medicine. Overcrowding is common in US EDs because many uninsured patients use the ED in place of a primary care doctor.

After two months, the percentage of patients who grew tired of waiting and left without being seen by a doctor dropped from 10% to a little under 4%. The greatest decrease in these walkouts occurred during the midnight-to-8-am shift, dropping from 20.6% to 8.9%. The new acute care unit has three treatment rooms, a waiting room, and a nurse's station. About 33% of the patients seen during the first 10 weeks were treated in the ED and then sent to the extended care unit for further evaluation and management, while 20% were held until a hospital bed became available, and the rest received treatment in the unit. In all, 32% of patients seen in the unit were ultimately admitted to the hospital.

"The amount of time we've had to be on ambulance diversion, when we couldn't take any more patients, has plunged more than 40%,” said Gabor D. Kelen, M.D., professor and chair of emergency medicine at Johns Hopkins. "Meanwhile, other nearby hospitals have increased their number of diversion hours 44%.” An added bonus, he noted, was a significant improvement in patient satisfaction scores.




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