Interventions to Assure Quality in the Crowded Emergency Department
The 2011 Academic Emergency Medicine Consensus Conference “Interventions to Assure Quality in the Crowded Emergency Department” will be held on June 1, 2011, immediately preceding the SAEM Annual Meeting in Boston, Massachusetts. Original papers on the conference topic, if accepted, will be published together with the conference proceedings in the December 2011 issue of Academic Emergency Medicine.
The Institute of Medicine’s (IOM) Committee on the Future of Emergency Care characterized hospital-based emergency care in the US as “at the breaking point.” Many emergency departments (EDs) face frequent and prolonged periods of crowding because of mismatches between capacity and demand for services. Several studies have found that ED crowding delays the timeliness of emergency care. Studies have also demonstrated the negative effect of crowding on the other dimensions of quality including safety, effectiveness, efficiency, equity, and patient-centeredness.
System-wide constraints and/or inefficiencies in the ED and the hospital, including the lack of bed availability, cause ED crowding. Therefore, system-wide solutions are needed at the ED, hospital, community, and national levels. Some EDs and hospitals have experimented with different strategies (e.g. staffing, communication, information technology, etc) to safeguard the quality of emergency care during capacity-constrained periods. The main focus of the conference will be to develop a research agenda to study interventions aimed at improving ED and hospital flow. However, attention will also be paid to public policy or health care reform changes that may influence crowding and the quality of emergency care.
The specific goals of the consensus conference are:
- To develop a research agenda that identifies promising interventions that safeguard one or more of the six IOM domains of quality of care during crowded periods in the ED;
- To review interventions that have been implemented to reduce crowding and summarize the evidence of their impact on the delivery of emergency care;
- To identify methodological challenges associated with the implementation and evaluation of interventions designed to safeguard the quality of emergency care during crowded periods; and
- To identify policy strategies as well as strategies used by other industries to optimize system performance and determine their applicability to solving quality of care problems associated with crowding in the ED.
Interventional research aimed at assuring quality of care during crowded periods may address any of the above objectives. Examples of research topics that would qualify include:
- Studies that seek hospital-wide solutions to crowding in the ED;
- Policy solutions (e.g. four hour rule in the United Kingdom or pay-for performance in Ontario,Canada);
- Information technology interventions that may be used to warn ED providers or administrators that conditions in the ED have reached an unsafe threshold;
- Interventions that enhance ED throughput (efficiency and timeliness); and
- Interventions that inform patients about delays in care and evaluate their impact on patient satisfaction (patient-centered care).
Original contributions describing relevant research or concepts in this topic will be considered for publication in the December 2011 special topics issue of AEM if received by Monday, March 26, 2011. All submissions will undergo peer review, and publication cannot be guaranteed. For queries, please contact Melissa McCarthy, ScD (mmccarth@jhmi.edu) or Jesse Pines, MD (jesse.pines@gmail.com), Consensus Conference Co-Chairs. Information and updates will also be posted in the SAEM newsletter and the AEM and SAEM websites.