We know that many hospitals in the country operate at capacity, and many patients are boarded in the emergency department. The literature is replete with the adverse consequences, including morbidity and increased mortality. It seems that it’s the way our system runs that creates this problem. We’re a nine-to-five, Monday-through-Friday system, trying to address a seven-day-a-week problem.

There are a few major initiatives to address this, including smoothing of elective admissions, which seems to have a profound effect on improving capacity. Early-morning discharges also have a strong impact on capacity, can virtually eliminate boarding, and also decrease the length of stay. The untouched area in the hospital industry has been weekends. Looking at the Statewide Planning and Research Cooperative System (SPARCS) data compiled by the New York State Department of Health reveals that discharges on a Saturday have an average length of stay of 3.9 days, but patients discharged on a Monday stay an average of 7.3 days.

I recently had a conversation with Peter Semczuk, DDS, MPH, and David Esses, MD, both with the Department of Emergency Medicine at Montefiore Medical Center, about how they solved their problems with ED boarding, particularly on weekends. The following is an edited transcript of our conversation.

Moderator

Peter Viccellio, MD, FACEP, is vice chairman of the Department of Emergency Medicine and associate chief medical officer for the Health Sciences Center at Stony Brook University in New York.

Participants

Peter Semczuk, DDS, MPH, is senior vice president and executive director of Montefiore’s Moses Campus in Bronx, New York. He is well-known for his work in emergency services, having overseen the expansion of Montefiore’s Department of Emergency Medicine to the second busiest in the nation.

David Esses, MD, FACEP, is a professor of clinical emergency medicine and vice chair and medical director at the Department of Emergency Medicine at Montefiore Medical Center, Moses Division, in Bronx, New York.

PV: David, would you describe what the emergency department was like before these interventions and then describe the interventions and what has changed at Montefiore?

DE: I’ll paint the picture of January and February of last year. We had an average of 29 patients waiting for beds at 8 o’clock in the morning. We would have more than a ward full of patients just waiting for beds every single day—that includes Saturdays and Sundays. About eight years ago, we hired a team of hospitalists to help take care of the patients who were waiting for beds.