Table 4.
Proposed Solutions to Overcome Ed Overcrowding
| Actions involving input | Ensuring priority of hospitalization for ED patients4 |
| Transfers between institutions permetted only if there are no patients awaiting admission in the ED4 | |
| Ambulances diversion to other hospitals presumed less crowded18 | |
| Incentivizing patients with less serious conditions to see their family doctor first, before going to the ED16 | |
| Addition of clinical assistant to each ED shift22 | |
| Investing in primary care16,17 | |
| To build home care and post acute care resources such as long-term care or rehabilitation services6 | |
| Forecasting emergency department flow3,10,17 | |
| Transference of admitted patients out of the ED rooms and into inpatient hallways15,19 | |
| Discourage boarding of admitted patients in ED exam rooms14 | |
| Actions involving throughput | Time-series analysis used to develop statistical models in order to forecast the patients flow in the ED10 |
| Increase bed of internal medicine19 | |
| Increase outflow of internal medicine patients from the ED to the internal medicine departments19 | |
| The access block viewed as a whole hospital problem and not only an ED problem23 | |
| The creation of a Patient Partner role21 | |
| Adding a dedicated triage space for patients who arrive by emergency medical services (EMS triage)13,14 | |
| Establishment of a rapid assessment unit (RAU) in ED21 | |
| Decrease requests for unnecessary advance diagnostic tests5 | |
| Development of a dashboard which provides real-time information regarding ED crowding20 | |
| Early identification of events that may worsen patient’s health24 | |
| Create a real time tool to inform patients about waiting times17,22 | |
| Improve the ED information system5,6,20 | |
| Improve patients post acute care6 | |
| Having a comprehensive view of patient flow in ED3 | |
| Optimize staff and resources3,10,15,18,23 | |
| Implementing additional resources and alternate care pathways3 | |
| Hospital beds priority at ED4 | |
| Patients registration process simply and fast15,21 | |
| Early identification of patients needing hospitalization or discharge24 | |
| Earlier administration of important therapies such as analgesia and antibiotics24 | |
| Close monitoring of specialties with the highest percentage of emergency room visits (cardiology, gastroenterology and pulmonology)11 | |
| Supplemented Triage and Rapid Treatment (START)24 | |
| Improve triage effectiveness12 | |
| Speed up the request for necessary diagnostic tests5,24 | |
| Actions involving output | Increased partnerships with social care service providers to facilitate discharge13 |
| To follow in the clinic patients already evaluated for the first time in the ED11 | |
| Discharge of ED patients before 12:00 and discharge of internal medicine patients by the morning shift19 | |
| Review of all patients in hospital for 14 days or more13 | |
| Decanting non-emergency lower acuity patients from the ED to a primary care clinic16 |