Proposed bill could help ease overflowing EDs
California is at the center of a national effort to ease emergency department overcrowding. The state Legislature is one vote away from sending the governor a bill that would require hospitals to use scoring assessments and set hospitalwide protocols to address the problem.
The proposed legislation comes at a time when emergency departments across the country are struggling to manage a growing hospitals to evaluate crowding levels in their emergency departments every four to eight hours using a scoring system with variables such as the total number of patients in the ED and most recent wait times. It would also mandate implementation of a full-capacity protocol that would determine what specific actions hospitals would take to improve throughput at each stage of crowding.
One of the biggest drivers of overcrowding, in California and elsewhere, is boarding, results seen at 676-bed LAC/University of Southern California Medical Center, Los Angeles, which uses the National Emergency Department Overcrowding Score system on which the California bill is based.
Another strategy mentioned in the video was the one developed by Peter Viccellio, vice chair and clinical director of the department of emergency medicine at 542-bed Stony Brook (N.Y) University Medical Center. In 2001, frustrated by overcrowding and “admitted patients, stacked in the ED waiting for beds,” Viccellio made a phone call, he explained. Although, like many clinicians, he believed it was against the rules to move patients elsewhere in the hospital, he called the state health department and found out he was wrong, Viccellio said.
“We got the health department to write letters telling hospitals that moving patients to other floors is allowable in times of high capacity,” Viccellio said. “If we become overcrowded and we have 20 patients to distribute, we try to put two on each of 10 floors so the burden is shared. It’s pretty obvious and I find it rather odd that it took so long to figure it out.”
The approach has led to shorter lengths of stay, quicker admissions and safer care, Viccellio said. Perhaps more importantly, it has encouraged the entire hospital to view ED overcrowding as an institutionwide problem that needs to be addressed by everyone. Another more proactive solution, he added, is to smooth surgical scheduling and redistribute work throughout the work week, making beds available more regularly.
“The 800-pound gorilla in the room is that hospitals continue to look at their business like it is a 9-to-5 event, and that’s where these traffic jams come from,” Viccellio said.
For now, the future of California’s overcrowding bill is uncertain. Despite support from the CMA and CAL/ACEP, the state’s public health department opposes the bill, contending that the scoring system would saddle beleaguered emergency departments with yet another task.
The California Hospital Association is neutral on the bill, said Debby Rogers, CHA’s vice president of quality and emergency services, and is currently pilot testing its own modified scoring scale with a group of 26 hospitals. Los Angeles County’s department of health services is also neutral, according to Carol Meyer, chief of operations, despite the fact that county-run USC Medical Center has used the scoring system effectively.
Whatever the fate of the bill, one thing is for sure, said Viccellio: Something must be done and quickly. “The failure to act in a serious way has clearly been horrible for patients and I find it inexcusable because the solutions require minimal resources.”
Overcrowded emergency departments in California will soon have protocols to follow to help ease overflowing if proposed legislation passes.