A bed management strategy for overcrowding in the emergency department

In 2006, the Institute of Medicine cited growing visit volumes, hospital closures, financial pressures, and operational inefficiencies as the principal reasons for emergency department (ED) overcrowding and called for regulatory measures to resolve the problem. A Midwest medical center with 59,000 annual ED visits instituted a bed management strategy to decrease the need to board, or hold, admitted hospital patients in the ED awaiting transfer to an inpatient care unit. This strategy was successful in improving the hold time from an average of 216 minutes to 103 minutes, or by 52%. This allowed the staff at the hospital to care for an additional 2,936 patients. During this same time, the overall hospital mortality decreased by 0.07% and patient satisfaction scores improved 1%. The greatest outcome from this intervention was realized in the potential revenue increase of over $2 million.