Reducing Emergency Room Overcrowding Univeristy


ReducingEmergency Room Overcrowding


Reducing Emergency Room Overcrowding

Emergencyroom overcrowding is among the leading challenges that face emergencynurses, physicians, and their patients, especially in most of thedeveloped countries. It is proposed that emergency room overcrowdingis a representation of the current equilibrium state of today’shealth care system. While this may be so, it does not guaranteesafety since there is enough evidence that patients may be harmed incrowded emergency rooms. Crowded rooms are a threat to timelydelivery of health care, antibiotic therapy, percutaneous orthrombolysis, and delays in analgesia intervention (Phua, Ngerng andLim, 2010). There is a reduction in other recognized health carestandards with regular medications in elderly patients omitted.Patients experiencing complexities in their needs are likely tooccupy the emergency rooms.

According to Harrisand Sharma (2010), studies show that the frail, elderly, and othercritically hailing patients have high chances of spendingdisproportionate time in the emergency room. Overcrowding alsocontribute to impaired dignity, completeness, and privacy of care.Hoot and Aronsky (2008) observed that an overcrowded emergency roomcreates challenges beyond the room. The ambulance crew may not ableto lift their patients, which reduces the capacity and resilience ofgiving pre-hospital services to attend to calls.

The patients sufferfrom overcrowding in these emergency rooms, and even suffer afteradmission. Again, there is a likelihood that the patients would beadmitted following the overcrowded rooms. According to Hughes andClancy (2007), this is mostly likely that the ability of theseemergency rooms is compromised following their failure to dischargepatients safely. In addition, Staff are also harmed by overcrowding,which results in the delivery of inefficient services.

TheProblem and Background

Despite thedescription of consequences, according to Phua, Ngerng and Lim(2010), the consensus is minimal in its definition of the problem.The background on “overcrowding” dictates abandoning the term,considering any form of “crowding” is harmful, especially when itinvolves nursing and health (Richardson &amp Mountain, 2009). Theproblem, however, allowsfor measurement and its subsequent research andpolicies evaluation. Other measurements include bed occupancy,validity, and moderate comparison of scales. A small thing likecounting all the patients that leaves before completion of treatmentis simple however, it ignores overcrowding complexity. Dennison(2007) noted that there are numerous overcrowding scales within theliterature, although most of them are limited by being choosy.

In December 2010,the New York States Department of Health received a letter directedto the hospital administrator. The letter was a reaffirmation of thehospital’s obligation to address overcrowding in the emergencydepartment and ambulance diversion. There were also numerousobligations, which included failure to admit patients in thedepartment’s emergency rooms, more so when another patient mayendanger his or her life (Blank et al., 2011). Another problemidentified is the fact that the emergency department overcrowding wasa menace to the entire hospital and not just the department.


The projectaims at completing a comprehensive and detailed assessment of the NewYork States Department of Health, in regard to the issue ofovercrowding. The assessment will be carried out and based on thefindings from the evidenced-plan all the issues put together will beaddressed. When patients’ condition are deteriorating because of alack of adequate and appropriate care, the proper assessment andevaluation of emergency department require a necessary tool so as toprovide solutions, which is based on the current literature.


Theimplementation of the project will be carried out over a period ofone to two months startingNovember 2015 with its implementation starting in December 2015. Allthe information about patients will be protected under the hospitalpolicies, according to Choo, Hutchinson and Bucknail (2010) November2015 will see the submission of the project proposal to the AmericanSentinel University. The stakeholders will assemble during thestipulated time and receive approval for collecting data and tools.In December, 2012, all the project data and the tools available willbe availed to the hospital, which include computer charting, scannedmedical records, pharmacy data, triage logs, and transfer log.

In the same period, the implementation process will start after allthe data has been carefully analyzed in search of appropriateindicators of the project research. The project will have to completea detailed assessment of the emergency department, which will beprocessed with RN, Evelyn Chu, Scott Lethi, and PharmD. Between 7thDecember, 2015 and December 27th December, 2015, theimplementation process will be carried out at the New York Statedepartment of Health. Data over the last two weeks after that will beanalyzed, written, and prepared. Finally, the last week will includethe evaluation, which will be presented to the American SentinelUniversity for critical review.


This projectwould be part of the overall operational budget of the entirehospital. All the associated costs would be funded through theoperations. The cost benefits of the entire project would beevaluated based on the net revenue contribution to all theoperations. The revenue was per the number of patients admitted onthe department of emergency rooms, the total percentage of thepatients attended to and released, and those treated and left withoutreceiving treatment. The expenses would also be based on the bed flowcost coordinator, increase in registered nurses during high-volumeperiods, those on full-time equivalents, more so for the licensedpracticing nurses within the department.

Fig. 1:Personnel expenses (benefits and salaries



Nursing benefits


Total personal expenses


Operating Expenses




Total operating expenses


Total projected revenue and income


Net profit



In order tooffer an improved quality of health care, the issues describedbeforehand must be solved. Considering the unpredictable nature ofhealthcare, it is essential to propose solutions that could assist inimplementing proposed project on ED issues. Blank et al. (2011) notedthat proposed implementation should be long-term rather thanshort-term approaches that only mask the problems for short period oftime, and thus the need for a long-term implementation of proposedprojections.

The comprehensiveimplementation of the project will take no less than three weeks,startingNovember, 2015 through to the end of December. Implementation willinvolve admission review of the logs, which would act as a referenceto the transfer delays from the crowded rooms, triage logs being areference to ED overcrowding, and reported medication errors fromrisk management and pharmacy.

This will follow asubmission of the project to the American Sentinel University forapproval. Submission will be followed by a meeting with keystakeholders to receive approval for the chosen data collectiontools. The available tools for example transfer logs and triage logswill be made available prior to analyzing the appropriate researchindicators (Olshaker, 2009). Finally, the project will be prepared,analyzed, written, and submitted to for review before data analysisis commenced.

Evaluationand Data Analysis

Admissionlogs were analyzed to look for specific reasons behind the delays ofpatient transfer from overcrowding emergency rooms. A lot of factorswere assessed, which included the average number of patients admittedin the ED during the assessment week, the highest and lowest numberof patients admitted in a span of 24 hours, the main reasons forholding the patients crowded in the emergency rooms, and the averagetime the patients were held in these emergency rooms. The main reasonfor overcrowding of patients was because of the unavailability ofbeds, tiny room size, and numerous admissions of the patients in thehospital.

Over the sameperiod of time, triage logs were reviewed, analyzed, and assessed dueto the reasons behind the overcrowding in the emergency rooms. Someof the factors accessed involved the longest time taken for triagesign-in, the longest time taken from the log to bed placement, andreasons for high admission of patients. The time taken for triageover the entire period in the emergency rooms was 1.33 hour. Some ofthe main reasons for overcrowding and long wait in the triage were asa result of the unavailability of space, beds, and the high number ofpatients admitted in the hospital. These patients had differentadmission levels such as medical-telemetry (MT), medical-surgical(MS), intensive care unit (ICU), and intermediate medical care (IMC).

Medication errorsreports were acquired from risk reports and management, which werelimited. Following the privacy and HIPPA laws, they were able to givegeneral data about the hospital in question. HIPPA is about the widemedical errors, which could not be broken down in the emergencyrooms. The risk management could never be disclosed on the specificdepartment of the hospital where the errors came from of the kind oferrors that occurred. In regard to the limited errors identified, itis imperative to offer education to nurses on the importance ofreported errors, even when they are minor.


There hasbeen evidence over increasing number of patients in emergency rooms.Overcrowding is as a result of lack of nursing staff and delay intransfer of admission, untimely discharges, and the lack of beds.Major themes that contribute to this problem of overcrowding are aresult of medication errors and delay of patient transfers. Theeffect of solutions to the problem includes short and long term goalstowards fixing the issues. One of the short term goals includeensuring the patients are moved to other ED areas. On the other hand,some of the short term goals include having increased resources anddemand management. The paper studied the New York States Departmentof Health and the project aimed at coming up with the timelinetowards implementation of the project carried out over a period oftwo months. The operational costs are shown by the budget, whichinclude expenses and salaries paid to the staff. Evaluation and dataanalysis used two tools admission logs and triage, which the paperidentified as assessment tools used for data analysis.


Blank, F., Tobin, J., Macomber, S., Jaouen, M., Dinoia, M., &ampVisintainer, P. (2011). A “back to basics approach to reduce edmedication errors. Journal of Emergency Medicine, 37(2), 141-7

Choo, J., Hutchinson, A. &amp Bucknail, T. (2010). Nurses’ role inmedication safety. Journal of Nursing Management, 18 (7)853-61

Dennison, R. D. (2007). A medication safety education program toreduce the risk of harm caused by medication errors. The Journalof Continuing Education in Nursing, 38(4), 176-184

Harris, A. &amp Sharma, A. (2010). Access block and overcrowding inemergency departments: an empirical analysis. Emergency MedicineJournal, 27(7), 508-11

Hoot, N. R. &amp Aronsky, D. (2008). Systematic review of emergencydepartment crowding: causes, effects, and solutions. AmericanCollege of Emergency Physicians, 52(2), 126-136

Hughes, R. &amp Clancy, C. (2007). Improving the complex nature ofcare transitions. Journal of Nursing Care Quality, 22(4),289-292

Olshaker, J. S. (2009). Managing emergency department overcrowding.Emergency Medicine Clinics of North America, 27(4), 593-603.

Phua, J., Ngerng, W. J., and Lim, T. K. (2010). The impact of a delayin intensive care unit admission for community-acquired pneumonia.European Respiratory Journal, 36(4), 826-33.

Richardson, D. B. &amp Mountain, D. (2009). Myths versus facts inemergency department overcrowding and hospital access block. MedicalJournal Australia, 190(7), 369-74