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ED Woes Bad Today, Worse Tomorrow

Joe Cantlupe, for HealthLeaders Media, July 12, 2012

Another major problem for EDs has been "boarding" which refers to patients waiting for an ED bed assignment.  This is an all-too-frequent phenomenon that is often seen as a culprit in ED occupancy and duration of stay. Hospital officials have been working to relieve the pressure on boarding for years, which has often resulted in ambulances diverted, and critically ill patients traveling farther for care, adding delays to their treatment.

"That was the second surprise," Pines said.

While boarding practices are certainly factors in crowding, they contribute significantly less than "practice intensity," which again includes "more frequent blood testing, greater use of advanced imaging and more frequent administration of intravenous fluids," the study states.

"We hypothesized that increased boarding of hospital admissions in the ED would be the most important cause of increasing levels" of occupancy in the ED, the report states. "This was not the case."

"We found that boarding is important and a big contributor," Pines says.  "If you looked particularly at the difference why length of stay was increasing over the eight-year period, it looked like it wasn't boarding going up, it was more practice intensity, taking the lab tests or blood tests. " 

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2 comments on "ED Woes Bad Today, Worse Tomorrow"


chris thomson (7/13/2012 at 8:33 AM)
The volume of testing is also directly related to the 'new' role of emergency departments in this era of more comprehensive care in the ED. Many patients treated frugally for their acute care needs in the traditional realm of emergency medicine simply return for follow up since they lack primary care. The role of the emergency department has extended far beyond emergencies. The options are to ignore this need or move to accommodate this need, and accommodating this need for care has driven increased care intensity. The pressures in the emergency department must be evaluated in the context of the healthcare system and its inadequacies.

Gus Geraci, MD (7/12/2012 at 3:36 PM)
You end with, "How can we get doctors to order fewer tests?" That's similar to asking, "How can we get pilots to crash fewer planes?" The reasons for test ordering go way beyond the desire of the physician, and to decrease the burden of time testing takes requires a thorough analysis of why tests get ordered, many of which you listed. How about phrasing the question, "How can we decrease the number of unnecessary tests ordered?" Thus not blacing blame on physicians, but including all the reasons unnecessary tests are ordered.