Journal Review
Kelen GD, Scheulen JJ, Hill PM. Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services division. Acad Emerg Med 2001; 8:1,095-1,100.
An acute care unit managed by the ED can significantly reduce overcrowding and ambulance diversion, say researchers from the Johns Hopkins University School of Medicine in Baltimore. A 14-bed acute care unit was opened in a remote location from the main ED, with 1,589 patients seen in the first 10 weeks of operation, comprising 14% of the ED volume. The number of patients who left without being seen (LWBS) decreased from 10.1% to 5%, and diversion decreased from 6.7 hours per 100 patients to 2.8 hours per 100 patients.
According to the researchers, an acute care unit is an effective way for the ED to control back-end patient flow. They noted significant reductions in patients who LWBS and ED diversion, compared with both a year earlier when ED patient volumes were lower and the immediate two-week period before opening the unit with similar high patient volumes. "By comparison, other local hospitals actually had substantial increases in diversion use," they report.
The researchers add that the patients who can be accepted to the acute care unit include primary patients, patients already evaluated in the ED, those determined to require admission, and patients needing observation or even intensive care unit-level care, and that more than half of the acute care unit patients received extensive diagnostic workups, admission processing, and acute management.
"We believe that increasing active patient care capacity available to the ED in a remotely situated acute care unit, which pushes the boundaries of traditional ED management beyond that conceived for ED-based observations units, stands as a potential solution to ED overcrowding, at least in some settings," conclude the researchers.
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