3.Control 'Artificial Variation'
A third suggestion that Sun called "the most effective, but also the most difficult," involves controlling "artificial variation."
"The numbers of patients who are admitted from the ED is like clockwork. It's very predictable. That is natural variation," Sun says.
"Artificial variation is when you have different needs for hospital beds that are based on things that physicians in the hospital can control. For example, let's say the surgeons in your hospital decide to do all their surgeries on Monday, Tuesday and Wednesday. On those days you are going to have a tremendous backup because all the inpatient beds are going to be taken up by post-surgical patients. Then for the rest of the week you then have oversupply of beds because those post-surgical patients are discharged and you have an excess of inpatient beds. Spread out the surgical schedule over an entire week."
Although the affects of healthcare reform on ED crowding were not addressed in the study, Sun was asked to speculate.
"That's a complicated question. Nobody really knows," he says. "It could make boarding worse because now that more people are going to be insured they will use the hospital more so that might contribute to ED crowding. We've seen this happen in Massachusetts where the expansion of insurance to pretty much the entire population at the least has not helped ER crowding and it probably has increased the volume of people who go to the ED."
"On the other hand, it might help in the sense that there are payment reforms going on and there is a big push to try to figure out how to keep patients out of the hospital. Right now it is really unknown. It could affect in both directions and nobody knows until we actually go to it."