Dear Editor:
We appreciate the comments from Drs. Patel and Vinson. Similar to their experience,1 we found that emergency department (ED) expansion alone does not significantly affect measures of ED crowding.2 Based on the data from these two centers and prior experience from a third hospital system,3 ED and hospital administrators should no longer expect improvement in ED metrics (ED length of stay, boarding hours, left without being seen, etc.) solely by increasing the size of their ED.
We agree that a multidisciplinary approach including hospital leadership and focusing on process improvement is a promising strategy for reducing ED crowding.1,4 Efforts to reduce ED crowding should consider both physical and process changes to the ED and hospital and not rely solely on ED bed expansion. Furthermore, rigorous study and publication of results of these efforts is needed to identify the best methods so that implementation beyond the local hospital is possible.
References
- 1.Patel PB, Vinson DR, Combs MA. Reducing emergency department admission wait times: two successful approaches. Ann Emerg Med 2013;62:S12. [Google Scholar]
- 2.Mumma BE, McCue JY, Li CS, Holmes JF. Effects of emergency department expansion on emergency department patient flow. Acad Emerg Med 2014;21:504–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Han JH, Zhou C, France DJ, et al. The effect of emergency department expansion on emergency department overcrowding. Acad Emerg Med 2007;14:338–43. [DOI] [PubMed] [Google Scholar]
- 4.Patel PB, Combs MA, Vinson DR. Reduction of admit wait times: the effect of a leadership-based program. Acad Emerg Med 2014;21:266–73. [DOI] [PubMed] [Google Scholar]