Citation

Baugh JJ, White BA, Biddinger PD, Raja AS, Wittbold KA, Sonis JD, Yun BJ. Am. J. Emerg. Med. 2020; 38(10): 2000-2001.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.ajem.2020.06.036

PMID

33142164

Abstract

While the COVID-19 pandemic has generated many new challenges for emergency departments (EDs) across the country, it has also created potential opportunities for the improvement of emergency care delivery, both during the pandemic and going forward. Certainly, in some hospitals, the lack of built-in reserve capacity that had previously led to chronic overcrowding and ED boarding resulted in even more unsafe crowding conditions during surges of COVID-19 patients. However, in other hospitals, like ours, a fundamental shift in operations allowed for markedly improved ED flow despite a markedly increased volume of high acuity patients. As EDs across the country continue to face decreased overall volumes (with the associated financial pressures that result), the actions of health system leaders and policy makers will determine whether we learn from the initial COVID-19 surge and improve our emergency care capabilities, or return to a status quo that could worsen emergency capacity even as we face a potential second COVID-19 wave.

In the last decade, overcrowding has become almost ubiquitous in EDs across the United States with many documented negative effects on both patients and healthcare workers. In the pre-COVID-19 era, providing high acuity care in hallway stretchers and chairs was the norm in our own ED, and patients routinely waited many hours before receiving inpatient beds. Despite treating more COVID-19 patients than any other hospital in a state with one of the highest numbers of cases nationally, patient flow through our ED and hospital in the past three months has, in fact, been better than at any time in recent memory. We intubated 3-4 times more patients than usual every day during peak COVID-19 volumes, and our total number of ED-to-hospital admissions remained similar to pre-COVID-19 levels, yet patients needing inpatient beds received them almost immediately and our hallway stretchers remained largely empty. Brisk ED outflow allowed us to safely manage our COVID-19 patient volumes in a manner that would have been previously impossible...

Language: en

Keywords

Disaster preparedness; Emergency department overcrowding; Hospital capacity; Hospital operations; Patient flow