According to the American College of Emergency Physicians, Americans made more than 115 million visits to hospital emergency rooms in 2003. Some of the most common complaints were stomach pain, chest pain, fever and cough. About 12 percent of those seen in the emergency room are admitted to the hospital.

Once a patient comes to the emergency department, healthcare workers make an assessment of needs. If a patient requires prompt care (such as for symptoms of a probable heart attack or stroke), he/she is seen very quickly. Patients whose symptoms are deemed less severe or are not life threatening are usually asked to wait. The National Hospital Ambulatory Medical Care Survey found in 2002, the average duration of a visit to the emergency room was 3.2 hours. However, the actual range of waiting time varied, with some patients waiting as long as 6 hours.

A big reason for long waits in the emergency room is overcrowding. The number of emergency rooms in the U.S. has decreased since 2001. But the number of patient visits has increased. In some areas, there is a serious shortage of nursing staff or medical specialists. That leads to longer waits and a potential need to divert ambulance patients to less crowded emergency rooms.

Speeding the Process

When an emergency patient needs to be admitted to the hospital, an in-patient bed is not always available. With no place to go, the patient is kept in the emergency department until a hospital bed is open. The practice of "boarding" patients in the emergency department contributes to overcrowding and longer waiting times.

To be efficient, a hospital must make the most use of open hospital beds. When a patient is discharged, housekeeping must be notified to clean the room. Someone may not be available immediately to prepare the room for the next patient. So a hospital bed sits empty. Even when the room is finally clean, it can take some time before the emergency room is notified about the bed availability.

At Lehigh Valley Hospital, administrators have revamped their procedures to make the most use of available hospital beds and get patients out of the emergency department more efficiently. The hospital uses specialized tracking software and a giant display screen (called a "bed board") to keep track of available hospital beds. As soon as an inpatient is discharged and leaves a hospital room, the bed tracking system is activated. The bed board, or giant tracking screen, displays a brown "bed" for that location. Housekeeping is automatically alerted to the need for room cleaning. Once the housekeeper has been paged, the "bed" on the screen turns into a yellow color to signify that room cleaning is in process. As soon as the room is clean and ready, the housekeeper dials a number to access the computer system and the bed board displays a "green" bed. The emergency department staff knows the bed is ready and the patient can be moved.

In the past, hospital staff relied on paper requests and telephone calls to find a bed for patient admissions. With the computerized tracking system, staff can immediately determine the availability and location of hospital beds. And if a bed isn't immediately available, they can track the status of rooms that are in process of being cleaned. Today, the bed turn around time (from discharge to availability) has been reduced from 210 minutes to an average of 62 minutes. And with the new bed tracking system in place, emergency department waiting times and patient diversions have been reduced by 50 percent.

SOURCES

American College of Emergency Physicians, http://www.acep.org