Crowded EDs leaving proven strategies for improving patient flow on the table.

While there is a plethora of proven strategies to address crowding, some of the most crowded EDs have failed to take full advantage of these tactics, according to a new study that examined the adoption of a range of both ED-based and hospital-wide interventions at hospitals between 2007 and 2010. The investigators are calling for a national strategy to address crowding as well as the implementation of new measures. They also say that more steps need to be taken so that hospital leaders are held accountable for ED crowding. Researchers found that the average number of interventions adopted to reduce crowding increased during the study period from 5.2% to 6.6%, but that some of the most crowded facilities failed to adopt interventions that have been proven to work well. For instance, 19% of the most crowded EDs did not use bedside registration and 94% did not adopt surgical schedule smoothing, an intervention that can be adopted at little or no cost. Investigators note that the hospitals that have been successful at addressing ED crowding are those that embrace systemic solutions.