A Full-Capacity Protocol Allows for Increased Emergency Patient Volume and Hospital Admissions.

PROBLEM: Our hospital was encountering problems with ED crowding. We sought to determine the impact of implementing a full-capacity protocol to respond to anticipated or actual crowding conditions. Our full-capacity protocol is based on collaboration among multiple hospital units.

METHODS: We completed a quality improvement initiative using a pre/post analysis of all ED patient encounters after implementing a full-capacity protocol with a corresponding period from the prior year. The principal outcomes measured were patient volume, admission rate, patient left without being seen (LWBS) rate, length of stay, and ambulance diversion hours.

RESULTS: In the post-full-capacity protocol period, a 7.4% increase in emergency patient encounters (P < .001) and an 11.9% increase in admissions (P < .001) were noted compared with the corresponding period in 2013. Also noted in the study period were a 10.2% decrease in LWBS rate (P = .29), an increase in length of stay of 34 minutes (P < .001), and a 92% decrease in ambulance diversion hours (111 fewer hours, P < .001).

IMPLICATIONS FOR PRACTICE: The collaborative full-capacity protocol was effective in reducing LWBS and ambulance diversion, while accommodating a significant increase in ED volume and increased hospital admission rates at our institution.