Emergency Department Overcrowding and Ambulance Diversion

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Emergency Department Overcrowding and Ambulance
Diversion

• James G. Adams, M.D.
• Professor and Chief
• Emergency Medicine
• Northwestern University/Northwestern Memorial
  Hospital

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Total Registered
Total Treated
Admissions
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We can predict problems tomorrow by projecting,
24 hours in advance

• Anticipated ED volume
• Surgical volume
• Anticipated discharges
• Transfers/direct admissions
• Current hospital volume

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Why would we want to predict problems?

• If we can predict problems that will occur
  tomorrow, we can respond today.
• If we fail to adequately respond, at least we
  can
• Know that we are optimally managing the system or
• Figure out ways to manage better or
• Know that there is simply no capacity!

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Once we predict a problem, then what?

• Notify medical staff
• What do they need?
• Notify managers and key leaders
• What do they need?
• Prioritize work to be done
• Labs, radiology
• Placement, rides home

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How can we begin this process?

• The hospital system must work together as a whole
• The demands of the ED, including bottlenecks,
  must be monitored
• 5 level, ESI Triage
• Real time process controls
• Information tools

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• If we monitor the hospital 24 hours in advance of
  problems, we also must monitor the ED on a
  real-time basis in order to identify
  unanticipated problems, bottlenecks, and surges.

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