Strategies for dealing with emergency department overcrowding: a one-year study on how bedside registration affects patient throughput times.

The objective of this study was to determine if the implementation of bedside registration would affect patient throughput times in an urban, academic emergency department. This was a before-and-after interventional study. An 8-month period before initiating bedside registration in November 2001 was compared to three subsequent 4-month intervals. Four times of day and three triage classifications were examined. Data were analyzed using a three-way analysis of covariance. There were 58,225 patient encounters analyzed. There was a significant difference in time from triage to room after bedside registration began (p < 0.0001). When examined by triage class, there were no differences in triage-to-room for emergent patients, a significant decrease for urgent patients initially and a significant decrease for non-urgent patients. Bedside registration by time of day initially reduced all four time-of-day periods but over the year they returned to pre-bedside registration levels, except for the morning period. Bedside registration decreased triage-to-room times for non-urgent patients and urgent patients initially, but this was not sustained at the end of 1 year. It had no effect on emergent patients who are routinely taken into the patient care area immediately. The sustainable effects of bedside registration were during the morning time when emergency department beds were available.