Easing the ER crowd 
Protocol alleviates the stress of overcrowding

EMERGENCY ROOMS are getting more crowded, with longer waits, according to a recent report published by the journal Health Affairs. In many ERs, patients who need to be admitted to the hospital are forced to wait in the emergency department (ED) until a bed opens up-a practice called "boarding."

One New York hospital has discovered a way to alleviate overcrowding, making the work of its nurses and health professionals easier, and improving patient care. Through its new "Full Capacity Protocol," Stony Brook Medical Center on Long Island has reduced crowding and gridlock by transferring admitted patients out of the emergency department to other floors where their needs can be met.

The program is working so well that it was recently featured on "NBC Nightly News" as a positive example of how hospitals are handling overcrowding in the ER.

"Our emergency department sees an average of 220 patients per day. This average is trending up," says Valerie Sayage, an ER nurse at Stony Brook and member of the New York Public Employees Federation (PEF), Division 225. "We realized that if stable but admitted patients were able to stay in an ED hallway, these same patients would be stable enough to go to the hall of their home unit, where the continuity of care would be better, more timely and certainly more private than in the emergency department," says Sayage.

Stony Brook's new protocol has made a tremendous difference in the functioning of the emergency department, she says.

"Being able to move admitted patients up to their home unit has freed up space to see and treat the inevitable incoming ED patients. This new-found space decreases our ED patients' wait time, which makes them happy, and is having a positive effect on the stress levels of our staff."

Not all patients embrace this idea, since they expect to be moved directly to a room once they are admitted. But given the shortage of hospital beds, that is not always possible. Although it's not ideal, the vast majority of people are very understanding, says Sayage. "Frankly, once they have spent some time in our ED halls, they are very willing to go to the hall of their home unit."

"Our floor is more private and more relaxing than the ED," says Dawn Diana, a nurse on the surgical oncology floor, which accepts pre- and post-operative patients from the emergency room. The influx of patients produces a lot of turnover. Even so, the patients seem happy, says Diana, also a member of PEF's Division 225. "They get more immediate care, and it's safer and quieter."

Stony Brook initiated the protocol three years ago, after staff had to start moving admitted patients to the emergency department hallway so they could continue to see incoming ED patients. The protocol has had a significant impact on the amount of time it takes to see and treat ED patients. It also has reduced the amount of time an admitted patient needs to stay in the hospital. "Discharges to home have been cut by nearly 24 hours," says Sayage.