Over the past year, the “boarding” situation in the ED has grown. Some mornings, we have 30 patients who have waited over night for a bed. Most days, there are 10+ patients waiting. Usually these are medicine patients but sometimes they include ICU, stepdown, and cardiac telemetry patients. We have added 15 staffed medicine beds over the past year, frequently “board” medicine patients on surgical floors (which sometimes backs up the OR and/or PACU), hold patients in the ICUs who are ready to transfer to the regular floor, and have increased case management and social worker coverage.
Even on a good day, we experience delays in moving patients and our ED order to actual admit time is far above the best practice benchmark of 2 hours. The average discharge time from an in-patient medical/surgical bed is between 3 and 4 pm.
As I talk to some of my CNO colleagues, this seems to be a challenge across the country. What strategies have you implemented to improve throughput and earlier discharges times? How do balance teaching and patient care? (I am at an academic institution.) How do you get buy-in to make changes?