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The Opportunity Loss of Boarding Admitted Patients in the Emergency Department

  1. Thomas Falvo DO1,3,*,
  2. Lance Grove RT, EMT-P1,
  3. Ruth Stachura RN3,
  4. David Vega MD1,
  5. Rose Stike MEd1,
  6. Melissa Schlenker BS2,
  7. William Zirkin MD3

Article first published online: 28 JUN 2008

DOI: 10.1197/j.aem.2006.11.011

Issue

Academic Emergency Medicine

Academic Emergency Medicine

Volume 14, Issue 4, pages 332–337, April 2007

Additional Information

How to Cite

Falvo, T., Grove, L., Stachura, R., Vega, D., Stike, R., Schlenker, M. and Zirkin, W. (2007), The Opportunity Loss of Boarding Admitted Patients in the Emergency Department. Academic Emergency Medicine, 14: 332–337. doi: 10.1197/j.aem.2006.11.011

Author Information

  1. 1

    Health Services Design Section, Department of Emergency Medicine

  2. 2

    Emig Research Center, York Hospital, WellSpan Health System, York, PA

  3. 3

    Graduate Division of Business and Management, School of Professional Studies in Business and Education, Johns Hopkins University, Baltimore, MD

**(Email: tfalvo@epix.net).

Publication History

  1. Issue published online: 28 JUN 2008
  2. Article first published online: 28 JUN 2008
  3. Received July 31, 2006; revised revision September 5, 2006; revised revision October 23, 2006; revised revision October 31, 2006; accepted November 1, 2006

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References

  • Case RB, Fite DL, Davis SM, et al. Emergency Department Crowding: Information Paper. Dallas : TX, 2004 Available at:http://www.acep.org/NR/rdonlyres/1FDC6583-A6F6-4022-95DF-92FCFFEE77F3/0/empcCrowdingPPR.pdf 2004 Accessed Nov 11, 2006.
  • Richardson L, Asplin B, Lowe R. Emergency department crowding as a health policy issue: past development, future direction Ann Emerg Med 2002;40:388–393.
  • Kellerman A. Crisis in the emergency department N Engl J Med 2006;355:1300–1303.
  • Institute of Medicine of the National Academies, Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services. The Evolving Role of Hospital-Based Emergency Care. Future of Emergency Care: Hospital-Based Emergency Care at the Breaking Point (Prepublication Copy: Uncorrected Proofs) Washington , DC : National Academies Press; 2006 pp 29–63.
  • United States General Accounting Office. Hospital Emergency Departments; Crowded Conditions Vary among Hospitals and Communities (GAO-03-460), 2003. Available at: http://www.gao.gov/new.items/d03460.pdf. Accessed Nov 11, 2006.
  • Derlet R. Overcrowding in emergency departments: increased demand and decreased capacity Ann Emerg Med 2002;39:430–432.
  • Asplin B, Magid D, Rhodes K, Solberg L, Lurie N, Camargo C. A conceptual model of emergency department crowding Ann Emerg Med 2003;42:173–180.
  • Schneider SM, Gallery ME, Schafermeter R Zwemer FL. Emergency department crowding: a point in time Ann Emerg Med 2003;42:167–172.
  • Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia Emerg Med J 2005;22:351–354.
  • Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects Ann Emerg Med 2000;35:63–68.
  • Richardson D. The access block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay Med J Aust 2002;177:492–495.
  • Henry M. Overcrowding in America's emergency departments: inpatient wards replace emergency care Acad Emerg Med 2001;8:188–189.
    Direct Link:
  • Krochmal P, Riley T. Increased health care costs associated with ED overcrowding Am J Emerg Med 1994;12:265–266.
  • Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 05-0046-2, May 2005. Rockville, MD: Agency for Healthcare Research and Quality. Available at: http://www.ahrq.gov/research/esi/). Accessed Nov 11, 2006.
  • Welch SJ, Allen TL. Data driven quality improvement in the emergency department at a level one trauma and tertiary care hospital J Emerg Med 2006;30:269–276.
  • Olshaker JS, Rathlev NK. Emergency department overcrowding and ambulance diversion: The impact and potential solutions of extended boarding of admitted patients in the emergency department J Emerg Med 2006;30:351–356.
  • Richardson D. Reducing patient time in the emergency department Med J Aust 2003;179:516–517.
  • Canadian Association of Emergency Physicians and the National Emergency Nurses Affiliation Joint Position Paper. Access to acute care in the setting of emergency department overcrowding Can J Emerg Med 2003;5:81–86.
  • Epstein S. American College of Emergency Physician Crowding Resources Task Force Presentation, 2004. Available at: http://www.acep.org/webportal/membercenter/chap/res/crowding/. Accessed Nov 11, 2006.
  • Welch SJ. The Emergency Department Performance Measure and Benchmarking Summit Emerg Med News June 2006:24–5 July 2006, pp, 8–9.
  • Williams R. The costs of visits to emergency departments N Engl J Med 1996;334:642–646.
  • Fields W. Calculus, chaos, and other models of emergency department overcrowding (commentary) Ann Emerg Med 2004;42:181–183.
  • Hughes D, McGuire A. Stochastic demand, production responses, and hospital costs J Health Econ 2006;22:999–1010.
  • Munoz E, Laughlin A, Regan D, Teicher I, Margolis I, Wise L. The financial effects of emergency department generated admissions under prospective payment systems JAMA 1985;254:1763–1771.
  • Eastaugh SR. Overcrowding and fiscal pressures in emergency medicine Hosp Top Res Perspect Healthcare 2002;80(1):7–11.
  • Brewster L, Rudell L, Lesser C. Emergency room diversions: a symptom of hospitals under stress Issue Brief Cent Stud Health Syst Change 2001;38:1–4.
  • Gallagher JE, Lynn SG. The etiology of medical gridlock: causes of emergency department overcrowding in New York City J Emerg Med 1990;8:785–790.
  • Proudlove NC, Gordon K, Boaden R. Can good bed management solve the overcrowding in accident and emergency departments? Emerg Med J 2003;20:149–155.
  • Geer R, Smith J. Strategies to take hospitals off (revenue) diversion Healthc Financ Manage 2004;58(3):70–74.
  • Healthcare Financial Management Association. Tackling the Capacity Crisis: Successful Bed Management Strategies (educational report). 2006. Available at:http://www.hfma.org/library/revenue/patientaccess/Capacity_Crisis_Successful_Bed_Management.htm. Accessed Nov 11, 2006.
  • McConnell KJ, Richards CF, Daya M, Weathers CC, Lowe RA. The economic impact of ambulance diversions[abstract] Acad Emerg Med 2005;12(Suppl 1):8–9.
  • Falvo T, Grove L, Stachura R Zirkin W. The financial impact of ambulance diversions and patient elopements Acad Emerg Med 2007;14:58–62.
  • Yancer DA, Forshee D, Cole H, et al. Managing capacity to reduce emergency department overcrowding and ambulance diversions Jt Comm J Qual Patient Saf 2006;32:239–245.
  • Showstack J. The costs of providing non-urgent care in emergency departments Ann Emerg Med 2005;45:493–494.
  • Reid PP, Compton WD, Grossman JH, Fanjiang, G Building a Better Health Care System: A New Engineering/Health Care Partnership. National Academy of Engineering and Institute of Medicine Report Washington , DC : National Academies Press; 2005.
  • Pindyck RS, Rubinfeld DL. Uncertainty and customer behavior. Microeconomics, 6th ed Upper Saddle. River : NJ, 2005 pp 214, 272–3.
  • Oscan Y Decision making in health care facilities. Quantitative Methods in Health Care Management: Techniques and Applications San Francisco , CA : Josey-Bass; 2005 pp 49–78.
  • Meigs R, Williams J, Haka S, Bettner M. Incremental Analysis. Accounting: The Basis of Business Decisions, 11th ed. Boston : MA, 1999 pp 863–4.
  • Drummond M, Stoddart G, LaBelle R Cushman R. Health economics: an introduction for clinicians Ann Intern Med 1987;107:88–92.
  • Bayley M, Schwartz J, Shofer R, et al. The financial burden of ED congestion and hospital overcrowding for chest pain patients awaiting admission[abstract] Acad Emerg Med 2002;9:367.
  • Drummond A. No room at the inn: overcrowding in Ontario's emergency departments Can J Emerg Med 2002;4:91–97.
  • Fernandes C. Emergency department overcrowding: what is our response to the “new normal?” Acad Emerg Med 2003;10:1096–1097.
  • Green LV, Soares J, Giglio JF Green RA. Using queueing theory to increase the effectiveness of emergency department staffing Acad Emerg Med 2006;13:61–68.
  • Kellerman AL. D'eja vu Ann Emerg Med 2000;35:83–85.
  • Forster A, Stiell I, Wells G, Lee A, Van Walraven C. The effect of hospital occupancy on emergency department length of stay and patient disposition Acad Emerg Med 2003;10:127–133.
  • Litvak E, McManus M, Cooper A. Root Cause Analysis of Emergency Department Crowding and Ambulance Diversion in Massachusetts. A report submitted by the Boston University Program for the Management of Variability in Health care Delivery under a grant from the Massachusetts Department of Public Health, Oct 2002. Available at: http://www.mass.gov/Eeohhs2/docs/dph/quality/healthcare/ad_emergency_dept_analysis.doc. Accessed, Nov 11, 2006.
  • Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Available at: http://www.bmjjournals.com. Accessed Feb 28, 2006.
  • Burt CW, McCaig LF, Valverde RH. Analysis of ambulance transports and diversions among US emergency departments Ann Emerg Med 2006;47:317–326.
  • Schull MJ, Lazier K, Vermeulen M, Mawhinney S, Morrison L, Asplin BR. Emergency department contributors to ambulance diversion; a quantitative analysis Ann Emerg Med 2003;41:467–476.
  • Hobbs D, Kunzman S, Tandberg D Sklar D. Hospital factors associated with emergency center patients leaving without being seen Am J Emerg Med 2000;18:767–772.
  • Fernandes C, Price A, Christenson J. Does reduced LOS decrease the number of ED patients who leave without seeing a physician? J Emerg Med 1997;15:397–399.
  • Rathlev NK, Chessome J, Olshaker J, et al. Effect of the elective surgical schedule on daily emergency department throughput time Ann Emerg Med 2004;44(Suppl 1):S29.
  • Bagust A, Place M, Posnett J. Dynamics of bed use in accommodating emergency admissions: stochastic simulation model BMJ 1999;319:155–158.
  • Derlet R, Richards J, Kravitz RL. Frequent overcrowding in US emergency departments Acad Emerg Med 2001;8:151–155.
    Direct Link:
  • Finkler S. The distinction between costs and charges Ann Intern Med 1982;96:102–109.
  • Wessels WJ. Chapter 1: What is economics all about. Economics, 3rd ed. Hauppauge : NY, 2000 pp 3–4.
  • Williams R. Ambulance diversion: economic and policy considerations Ann Emerg Med 2006;48:711–712.
  • Bamezai A, Melnick G, Nawathe A. The cost of an emergency department visit and its relationship to emergency department volume Ann Emerg Med 2005;45:483–490.
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