DR. HEMMERT is the medical director for the Department of Emergency Medicine at the Hospital of the University of Pennsylvania in Philadelphia, and an assistant professor of clinical emergency medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He is also the founder and associate fellowship director for the emergency medicine administration and leadership fellowship, a groundbreaking collaboration with the Wharton School in Philadelphia.
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ACEP Now: Vol 42 – No 08 – August 2023DR. PINES (@DrJesspines) is the chief of clinical innovation at US Acute Care Solutions and a professor of emergency medicine at Drexel University in Philadelphia. He works clinically as an emergency physician at George Washington University Hospital in Washington and Allegheny General Hospital in Pittsburgh.
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One Response to “ED Boarding”
August 22, 2023
Christian TomaszewskiGreat suggestions in your five recommendations.
Unfortunately, in California #2 and #3 (offsetting nursing tasks) do not really work. The bottleneck is the nursing ratio (4:1, except ICU cases 2:1). You can hire all the LVNs and techs you want; we cannot violate that ratio. And for some reason, waiting room patients do not count in the ratio, and so get “ignored.” We need waivers for ratios, on both the inpatient and ED sides to cope with the volume, provided we do give nurses help with such “care extenders.”
As for #5, yes, ED physicians need to engage with population health. But decreasing overall ED volume is not necessarily the answer. The worried well to some extent subsidize ED operations. We could certainly accommodate many more Level 3/4 triage patients (treat and discharge) if we were not holding so many admissions in the ED, which lengthens every ED patient’s workup and stay.