Emergency Department Physicians

Brent R. Asplin, MD., Chair of the Emergency Medicine Department at Mayo Clinic, Rochester, MN

Insufficient inpatient beds is the main reason for ED boarding, overcrowding and diversion, right? Wrong. Despite this common belief, our research in hospital patient flow systems has shown that the chief problem is neither the number of inpatient beds nor the inefficiency of ED internal processes. The problem is that a bed is not available when it is needed.

The right bed is usually not available at the right time because of competition for resources between patients admitted from the ED and elective admissions. This competition is a result of artificial variability in patient flow, which in turn is driven by inappropriate scheduling of elective patients. Better management of the flow of elective admissions provides a sustainable solution for your intractable ED overcrowding and boarding problems.

Aside from boarding and overcrowding issues, ED operations are complicated by the broad array of services provided for a wide range of patient types. At its core, an ED’s challenge is to service variable demand with fixed capacity. How various care processes and resources are organized can have a significant impact on the overall efficiency of an ED. The science of operations management offers some of the best tools, such as queuing models, separation of homogenous patient streams, and the critical path method, for determining ED workflow design and resource allocation.