Hospital Strategies for Reducing Emergency Department Crowding: A Mixed-Methods Study

Area of Science:

• Healthcare Management
• Hospital Operations
• Quality Improvement

Background:

• Emergency department (ED) crowding and patient boarding negatively impact mortality rates and patient satisfaction.
• Identifying effective strategies to mitigate ED crowding is a critical healthcare challenge.

Purpose of the Study:

• To identify strategies employed by high-performing hospitals to reduce emergency department (ED) crowding using a positive deviance methodology.
• To understand the organizational characteristics associated with reduced ED length of stay and improved patient flow.

Main Methods:

• A mixed-methods comparative case study design was used.
• Hospitals were selected based on Centers for Medicare & Medicaid Services (CMS) case-mix-adjusted ED length of stay and boarding times.
• Interviews were conducted with 60 key leaders across high-performing, low-performing, and improving hospitals.

Main Results:

• ED crowding was universally recognized as a hospital-wide issue.
• No single intervention was consistently linked to improved length-of-stay metrics.
• Four organizational domains were associated with better hospital performance: executive leadership, hospital-wide coordination, data-driven management, and performance accountability.

Conclusions:

• Organizational characteristics are significantly associated with reduced ED length of stay.
• Hospitals with strong organizational domains are better equipped to implement successful ED crowding reduction interventions.
• These findings offer actionable insights for other hospitals seeking to address ED crowding and improve patient care.