The real solution to ED overcrowding
There have been a number of studies and reports conducted on the issue of emergency department overcrowding and ambulance diversion that offer a number of alternative solutions, including one commissioned by the Department of Public Health, and none of them call for the placement of patients in hallways.
There are three root causes of the overcrowding problem in Massachusetts:
- Understaffing of registered nurses to allow for full utilization of existing hospital capacity to allow for efficient transfer of patients out of emergency departments onto inpatient units.
- A shortage of beds in the system due to hospital consolidation caused by the industry’s reliance on a cut-throat free-market model of health care delivery.
- A failure of hospital administrators to manage non-emergent, elective surgeries and admissions by physicians to control bed utilization and availability.
The solutions promoted by the MNA that responds to these root causes include:
- Passage of legislation to regulate RN-to-patient ratios in all acute care hospitals, which includes a ratio for nurses in the emergency department. This law will guarantee full staffing to allow for opening up of bed capacity to ease overcrowding; and it will end the current shortage of nurses who are refusing to work in hospitals because of the current conditions.
- Creation of a safe, properly-equipped holding area (not a hallway) for patients awaiting a bed on an inpatient unit. This area must be safely staffed with nurses dedicated to caring for those patients. In no instance should an ED nurse be assigned to cover treatment rooms in the ED and still be responsible for patients in a hallway.
- Staff to full-bed capacity as opposed to the current practice of providing staffing based on an estimated average daily census. Even with the loss of bed capacity in our state’s hospitals, in many instances, there are beds available for patients in the hospital; there are just no nurses available on that shift to staff the beds. The Institute of Medicine, in its groundbreaking report on nurse staffing and patient safety, recommends that hospitals overstaff units to account for and manage variability in patient flow.
- Mandating that hospitals take appropriate control of elective admissions or regulate suitable hospital discharge procedures to smooth admissions and allow for the capacity to handle spikes in emergency department utilization. The DPH commissioned a study by a team of Boston University researchers who have developed just such a system for hospitals. The program has been adopted by Boston Medical Center and has been working well. But no other hospital in Massachusetts is adopting these policies.
- Adequately staff ancillary departments to allow for rapid cleaning and turnaround of rooms. In many instances, there is a staffed bed available for a patient, but there is a delay in turning over the room.
- Ambulance diversion to a well-staffed hospital with the capacity to properly care for a patient is safer than overloading a hospital that is already filled to capacity, thus necessitating care in a hallway.
- The DPH needs to assess current and future bed capacity, and the state needs to ensure the provision of an appropriate number of beds throughout the state to provide safe, dignified care to the residents of the commonwealth.
The MNA continues to research methods of dealing with ED overcrowding that do not involve corridor care and will educate its members and the nursing community about these alternatives.
It will be conducting a survey of emergency department nurses to determine what hospitals across the state are doing to deal with this crisis and most important of all, it will be pushing for passage this year of legislation to regulate RN-to-patient ratios in hospitals, which is a lynchpin to a true system wide solution.
To review the MNA position statement on this issue, click here.