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Clinical Systems Leadership

How Nurses Can Reduce ER Crowding

One of the largest complaints patients state during their visits to the hospital is the amount of time they have to wait to see a medical professional. According to the Centers for Disease Control and Prevention, the average emergency room standby period is around two hours – 30 minutes of waiting and 90 minutes for treatment.

This is a substantial concern, not only for patients but also for health-care providers themselves. Let’s take a closer look at the problem:

Impact of overcrowding

In addition to the reduction in customer satisfaction that comes with long periods of waiting before seeing a nurse or doctor, emergency room overcrowding results in a number of other outcomes. One of the most prominent negative effects is the higher chance of medical error. The likelihood of high-stress decision-making, as well as lack of space for patient care, can add a lot of pressure on health-care providers. As a consequence, nurses and doctors may miss a crucial element in a patient’s chart or overlook a symptom that could cause a larger problem down the line.

The stress that comes with overcrowded waiting rooms could also have a negative impact on health-care professionals. This challenge can be extremely overwhelming, causing nurses and doctors to feel stress that much faster. If health-care providers start to feel burnt out, hospitals will need to find ways to ease the pressure they feel and retain valued staff members.

: ER overcrowding is a common, but solvable issue.

Hospital personnel, especially nurses, can play a role in reducing overcrowding in ERs across the country by taking the following steps:

Implement nurse-driven rules of conduct

The primary responsibility when searching for methods to decrease wait times for patients is introducing techniques that will improve the flow of patients without putting their quality of care into jeopardy.

A new study published in the Annals of Emergency Medicine journal recommends creating protocols that enable nurses to begin patient treatment before people are seen by a doctor. Of course, this strategy may not work for everyone entering an ER waiting room but these rules of conduct were proven to cut wait times most effectively for patients experiencing fever, hip fractures, vaginal bleeding during pregnancy and chest pain.

It is important that these guidelines are developed carefully, as each hospital will have its own concerns to monitor. While the health conditions targeted in the study may work for some ERs, that specific policy may not work as successfully for others. Nurses should work with hospital management to create these procedures, as they will be the first health-care providers to interact with waiting patients.

Identify frequent visitors

To make nurse-initiated guidelines effective, it is critical for hospitals to pinpoint certain factors related to regular ER visitors. These “frequent flyers,” as they are referred to in the health-care field, tend to utilize public health nursing, community welfare, social work, and psychiatric services, as well as addiction counseling, more often than the rest of the general population in the waiting room.

Patients who are 65 years or older are also another cause of overcrowding, as sickness and falls are increasingly common at this age. After identifying these regular ER visitors, hospitals have to find a way to curb re-admissions and decrease the likelihood of people returning in the future. It all starts with care coordination.

AMN Healthcare recommends the following actions to reduce the number of hospital stays frequent patients undergo:

  • Educate people on various health care options related to their specific condition: The ER is not the best setting for patients with stable, chronic and low-intensity problems.
  • Implement a transition process for patients with a primary care provider: Nurses can help people identify physicians accepting new patients and facilitate initial communication prior to ER discharge.
  • Utilize case managers to discuss the best care settings for high-risk patients.
  • Ensure communication between the hospital and primary care physicians is thorough to avoid repeat hospital stays.
  • Employ a nonclinical community health worker to help patients navigate the health care system.
  • Implement case management methods to address substance abuse problems.

While not catch-all solutions, these suggestions could assist hospitals reduce overcrowding and help nurses dedicate time to the most sensitive patient cases.

Obtain leadership support

Every emergency department has access to different resources that can improve the overcrowding problem faced by its health-care providers. Yet, the one thing all of these facilities have in common is the need for backing from administrative managers and supervisors. These champions will likely have a better understanding of the financial capabilities the hospital has to implement certain strategies for improving patient flow.

Hiring additional staff may be an option to curb long wait times, however, this action requires funds some hospitals may not have in their budget. Other plans of action may be more feasible but will need the support of health-care leaders to be implemented successfully and without hiccups. Nurses should present their ideas to their managers as well as emergency room physicians and doctors who will also be affected – hopefully in a positive way – as a result of these plans.

Gaining support from facility leaders can help nurses implement steps to reduce overcrowding.

Introduce pre-visit services

Sometimes the key to preventing ER overcrowding comes down to helping people before they enter the hospital. Nurse-assistance phone lines enable patients to talk with a health-care provider prior to their visit in a more efficient manner. Presenting their symptoms or conditions through this tool allows medical professionals to improve triage flow and decide what course of action is best for the patient’s safety. Although this service can be expensive to operate, many facilities have found the benefits to be more important than the cost.

Another option is implementing computer-supported wait-time trackers. These programs show patients just how long they will be on standby before seeing a health-care professional during an ER stay. With this information at their disposal, people can prepare themselves for the hospital or look to other health-care resources for treatment. This service can be especially helpful for frequent-flyer patients. Their desire to visit the hospital instead of the care coordination that may have potentially already been developed for them could be reversed if they know their wait time ahead of their visit.

Go vertical

Since nurses treat such a wide variety of patients they are often on the front lines when it comes to the emergency department. As a result, these health care providers are able to pinpoint when triage starts to experience a bottleneck or when overcrowding becomes an issue. To differentiate between a normal amount of patients and too many, some facilities have implemented multiple categorical modes that define how health-care professionals, especially nurses, operate within the ER. This strategy – called “going vertical” – can be extremely helpful and should be tested to better understand its benefits.

Corresponding with patient volume, nurses on the floor can call for vertical mode. This means patients with non-emergent issues of low intensity are moved to a designated area with particular recliners after examination. Since their results are in progress, nurses will observe these people as they wait to be discharged. As a result, more pressing cases in the waiting room have access to beds and stretchers. The practice only has to last as long as the bottleneck itself. Once the overcrowding has ceased, nurses can call for a reversion to a regular care-taking mode.

Utilize telemedicine

Health care is moving in a digital direction, much like a number of other industries. Hospitals and their nursing staffs should embrace technology as it could help reduce overcrowding in the ER. Telemedicine solutions offer health-care professionals the ability to ensure patient flow is steady and effective.

Patients should be able to access this service while at home, as well as during their hospital visit. The ability to speak with a nurse about their symptoms can enable people to gauge whether what they are experiencing requires a trip to a facility. For patients already in the waiting room, telemedicine treatment can decrease the amount of time they have to wait to see a health-care provider. In a study conducted by the University of California San Diego’s Health System, designated patients were transferred to telehealth portals where experienced personnel equipped with specialized equipment could examine and treat their conditions.

Not only did this cut down on ER wait times, but there was no sign that those patients who received telemedicine assistance were more likely to experience miscommunication or be misdiagnosed.

Crowded emergency rooms are a common occurrence for hospitals across the country. Taking a few crucial steps could lessen this burden for health-care providers and nurses can be the catalyst for this change. As health care professionals who see a large number of patients, they can speak up to suggest and implement actions that will improve patient flow and satisfaction without compromising overall quality of care.

Earning a Master of Science in Nursing degree from the University of Arizona will give nurses the tools and advanced knowledge they need to introduce impactful changes designed to better the ER experience for patients and health-care providers alike.


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