Arcadia Medical Center: Emergency Department Crowding (A)

Arcadia Medical Center's newly appointed medical director of operations for the department of emergency medicine has noticed a gradual increase in the length of time it takes for patients to be seen and their care completed. He frequently examines patients who are waiting in their stretchers in hallways in an effort to expedite patient care. It is becoming increasingly difficult to maneuver through the overcrowded emergency department to perform routine patient care activities. Having considered how to improve the crowding issue, the medical director of operations has created a team to analyze the situation and make recommendations to implement change. Excerpt UVA-OM-1468 Rev. Oct. 21, 2019 Arcadia Medical Center: Emergency Department Crowding (A) Early for the meeting, Dr. Marc Schuler sat in a conference room at Arcadia Medical Center (AMC) and stared at a thick file containing his recent notes about the current state of the emergency department (ED). Schuler was AMC's newly appointed medical director of operations for the department of emergency medicine. During the 10 years he had been working at AMC, Schuler had noticed a gradual increase in the length of time it took to see patients and complete their care. He frequently examined patients waiting in their stretchers in hallways in an effort to expedite patient care. The overcrowded ED at AMC looked more like an early–20th century infirmary than a state-of-the-art ED. It was becoming increasingly difficult to maneuver through the ED to perform routine patient-care activities. This was not how he had envisioned practicing medicine in 2008. After having considered how to improve the crowding issue, Schuler had decided his first task was to create a team. Given the complex nature of implementing change in the department, he would need the help of the nursing staff and the support of the hospital administration and the academic chair of the emergency medicine department. Cindy Locker, the ED nurse manager, had observed her nursing staff becoming increasingly stressed and overwhelmed by the patient volume, the lack of communication in the ED, and the amount of time patients waited to receive care. When Schuler had asked Locker to lead the team, she had agreed. Schuler and Locker had already selected five people for the ED crowding team. Schuler still needed to pick another physician, and Locker had to choose another nurse. They had also contacted the quality improvement (QI) office to ask for a staff member to assist in the technical aspects of the data analysis. . . .