Leaning Emergency department for

crowding

By Group C
Dr Munawar
Dr Hafeez
Dr Fariha
Dr Jamil
Dr Afsah
HN Iqra
• MISSION-
• To develop model emergency department where quality care provided to
patients with minimum delays and waiting/crowding
• VISION
• Our vision is to be leader by transforming emergency healthcare system in
pakistan
• VALUES:
• Access- serving all the patients coming to our emergency department
• Quality- high quality of care to all
• Team Work- within department & with intradepartmental colloboration
• Leadership- to be role model & inspire other ED to achieve the same
• Our Mission is to provide the best quality care to sick patients with minimum delays , educate and mentor
the next generation of physicians and staffs, and to improve health and healthcare networks through innovative
research and evidence based medicine.

• Our Vision we aspire to develop , transform a role model Emergency medicine department to achieve the
Aim by implementing effective care strategies proven through innovative and rigorous research into practice and
educating health care teams to implement such strategies.

• Our values
• Excellence & Discovery - Be the best. Commit to exceptional quality and service by encouraging curiosity, seeking
information and creating innovative solutions.
• Leadership & Integrity - Be a role model. Inspire others to achieve their best and have the courage to do the right
thing.
• Teamwork - Be collaborative. High-functioning multidisciplinary teams create the best results for patient care,
education and research.
• Creativity - Think outside the box. The best solutions to the biggest problems like disasters, often require imaginative,
innovative thinking which involves a significant change from the traditional approach.
• Crowding –
• “ACEP“ Crowding occurs when the identified need for emergency services
exceeds available resources for patient care in the ED, hospital, or both.

• Patient Flow - It is specifically the movement of patients through the

department as they are evaluated, treated, and released or admitted to the hospital
Impact of flow on ED performance

10 10 10
Rooms Rooms Rooms
ED ED ED
Throughput:4 Throughput: Throughput:
hours 3 hours 2 hours

ED Capacity: ED Capacity: ED Capacity:

60/day 80/day 120/day
ED Flow
Input Throughput Output
Lack of access to follow-up care

Ambulance Patient arrives to

diversions ED
Emergency Care Left
Seriously ill from Ambulatory
without
the community and Care System
being
referral sources Triage and room seen
placement

Unscheduled
Urgent Care Diagnostic Patient Transfer to
Lack of available Demand for ED evaluation and Disposition outside
ambulatory care care
Desire for treatment facility
immediate care

Admit to
Safety Net Care ED boarding of hospital
Vulnerable
populations inpatients
Access barrier
Lack of available staffed inpatient beds

COURTESY ACEP
ED Overcrowding!
Input Throughput Output

Lack of access to follow-up care

Ambulance Patient arrives to
diversions ED
Emergency Care
Seriously ill from Left Ambulatory
the community and without Care System
referral sources being
Triage and room
seen
placement

Unscheduled
Urgent Care
Diagnostic Transfer to
Lack of available Demand for ED Patient outside
ambulatory care care evaluation and Disposition facility
Desire for treatment
immediate care
Admit to
hospital
Safety Net Care ED boarding
Vulnerable
populations
of inpatients
Access barrier
Lack of available staffed inpatient beds

COURTESY ACEP
In-Put Issues
• Triage time is usually 3-5 minutes
• We follow the 4 level triage model (P1-P4)
• Two RN and 1 NA in staff for triaging the incoming patient
• During surge hours when after 11 am when patient flux increase one
consultant also cover the triage area
• This will help to start –
• physician at triage – model where both RN and physician simultaneously
evaluate the stable patients
• Split flow model – channeling out the low acuity patient and keep vertical
patients vertical
For through-put issue
• Working on 12 hours shift base , 8am -8 pm and 8pm -8 am
• During each shift one consultant cover major and one cover minor area
• Team lead also one in major and one in minor area
• Junior physician – 3 in resus room, 2 in major, 1 in minor and 1 in clinic
• During the surge time an additional shift start working from 11 am till 9 pm
• During that shift one additional consultant cover major and minor area
• One shift lead in major area
• 2 additional junior physicians placed in resus and major area
• And 1 additional junior physicians in minor and clinics
Throughput issue – contd.
• For Laboratory STAT lab and POC tests should be available in ED so
waiting time for lab result should be decreased
• Similarly potable radiology should be available
• Parallel working of physician and staff can reduce the nursing and
then physician assessment time
• Real Time dash board in ED who can give whole ED situation in a
glance
• Measuring different KPI will help to review the data and plan for
future
For Out-Put issue
• Bed Management team- who can coordinate between ED and
different inpatients unit for timely discharges and bed availability

• Early discharges from the ward so in patient beds are timely available
for boarded patients in emergency department

• Can establish an observation unit adjacent to ED where those patients

who are P3 category and just need to stay max of 24 hours can be
kept and manage so main ED beds are available for incoming patients