Study finds most crowded US hospitals did not adopt proven interventions

The most crowded emergency departments in the U.S. have not adopted proven interventions to address crowding, a major public health concern.

Researchers at the George Washington University (GW) looked at crowding in U.S. hospitals from 2007-10 and found that while the adoption of strategies to reduce emergency department crowding has increased, many of the nation's most crowded emergency departments have not adopted effective interventions.

"Emergency department crowding is clearly linked to worse patient care and worse outcomes, including higher mortality rates, higher rates of complications, and errors," said Jesse M. Pines, M.B.A., M.D., director of the Office for Clinical Practice Innovation, professor of emergency medicine and health policy at the GW School of Medicine and Health Sciences. "Patients also, no surprise, have a poorer patient experience. People want fast and effective care, and many of our nation's most crowded emergency departments have not addressed this problem despite the wide availability of proven interventions."

The study, published today in the December issue of Health Affairs, found the average number of interventions adopted increased from 5.2 to 6.6 percent over four years. While the most crowded emergency departments increased implementation of crowding interventions, there was still a gap in adoption of interventions that have been shown to work. For example, 19 percent of the most crowded emergency departments did not use bedside registration, and 94 percent did not use surgical schedule smoothing, which helps plan surgical schedules to match inpatient bed availability.

"This data implies that emergency department crowding is still a low priority in many hospitals, despite the fact that it has continued to worsen over the last two decades," said Leah S. Honigman Warner, M.D., M.P.H., who was an attending physician in the Department of Emergency Medicine at GW at the time this research was completed, and is now an attending physician in the Department of Emergency Medicine at Long Island Jewish Medical Center. "With implementation of the Affordable Care Act and pressure to reduce health care costs, crowding will likely continue to worsen. We know there are effective interventions that can mitigate crowding, now is the time to develop best practices to reduce emergency department crowding so that we can provide the highest-quality patient care."