ArticleAnnals of emergency medicine2018
Hospital Strategies for Reducing Emergency Department Crowding: A Mixed-Methods Study.
Article in Annals of emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 3 of them syntheses that pooled it.
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Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Challenges, consequences, and lessons for way-outs to emergencies at hospitals: a systematic review study.BMC emergency medicine · 2019Pooled it
- Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies.BMJ quality & safety · 2019Pooled it
- Emergency department crowding: A systematic review of causes, consequences and solutions.PloS one · 2018Pooled it
- A clinical activation protocol improves response time to urgent/emergent neurosurgical care in children with brain tumors and intracranial hemorrhage.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- Where's the way out? Access block, boarding and hospital overcrowding: a narrative review.Internal and emergency medicine · 2026Review
- Waiting for a hospital bed: Disparities in emergency department boarding.Journal of hospital medicine · 2026Article
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- Design and cost-effectiveness assessment of a model based on point-of-care testing for the improvement of the resolution of hospital emergencies.Advances in laboratory medicine · 2025Article
- Development of an emergency department length-of-stay prediction model based on machine learning.World journal of emergency medicine · 2025Article
- Continuous quality improvement across a South Australian health service and the role it plays in a learning health system: a qualitative study.BMC health services research · 2025Article
- Using positive deviance to enhance HIV care retention in South Africa: development of a compassion-focused program to improve the staff and patient experience.BMC global and public health · 2025Article
- Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study.JMIR human factors · 2024Article
- Using Positive Deviance to Enhance HIV Care Retention in South Africa: Development of a Compassion-Focused Programme to Improve the Staff and Patient Experience.Research square · 2024Article
- Tell me why, I don't like Mondays.CJEM · 2024Article
- Article
- The use of positive deviance approach to improve health service delivery and quality of care: a scoping review.BMC health services research · 2024Article
- Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes.Internal and emergency medicine · 2024Review
- Review
- Challenges in traumatic spinal cord injury care in developing countries - a scoping review.Frontiers in public health · 2024Article
- Article
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11 authors.
Funding
Abstract
STUDY
objectiveEmergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding.
methodsIn this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012. We also recruited hospitals that showed the highest performance improvement in metrics between 2012 and 2013. Interviews were conducted with 60 key leaders (physicians, nurses, quality improvement specialists, and administrators).
resultsWe engaged 4 high-performing, 4 low-performing, and 4 high-performing improving hospitals, matched on hospital characteristics including geographic designation (urban versus rural), region, hospital occupancy, and ED volume. Across all hospitals, ED crowding was recognized as a hospitalwide issue. The strategies for addressing ED crowding varied widely. No specific interventions were associated with performance in length-of-stay metrics. The presence of 4 organizational domains was associated with hospital performance: executive leadership involvement, hospitalwide coordinated strategies, data-driven management, and performance accountability.
conclusionThere are organizational characteristics associated with ED decreased length of stay. Specific interventions targeted to reduce ED crowding were more likely to be successfully executed at hospitals with these characteristics. These organizational domains represent identifiable and actionable changes that other hospitals may incorporate to build awareness of ED crowding.
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