Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

ED overcrowding: every clinician can help


Collaboration between healthcare professionals across the hospital is crucial to reduce ED overcrowding and improve patient care. One thing clinicians can do is help patients leave the hospital as soon as they are ready. 

If you’ve ever been sick and spent hours in an emergency department, waiting for an inpatient bed and feeling miserable, you already know it’s important that clinicians address ED overcrowding in every way possible. But it’s not just patient comfort that we’re optimizing when we do active bed management. Keeping patients in the emergency room after admission is associated with poor health outcomes, including mortality.    


During the COVID-19 pandemic, I had a critically ill patient who spent more than three days intubated in the ED. His family was offered transfer to a bed at another hospital that they declined. Although the emergency medicine team did their best, ongoing management of critically ill patients isn’t their area of expertise.   


Eventually the patient made it into the MICU where he died of multiorgan failure. Could a quicker disposition into a critical care bed have made a difference? Possibly.    


How does this apply to you? If your hospital, like many is the U.S., is at full capacity all the time, then you can play a role in mitigating the harms of long stays in the ED. Prioritizing discharges, discharging earlier in the day and earlier in the patient’s stay, keeping outpatient tests for the outpatient setting, and assessing potential rehab discharges for suitability for outpatient or home rehab are all things we can do to potentially reduce inpatient time. Even small changes in our work can abbreviate stays in the ED.     


At my hospital, we have a person whose job is to address throughput and capacity, 24/7.  But throughput, and relieving ED overcrowding, is truly the responsibility of everyone in the hospital: clinicians, nurses, environmental services workers, case managers, and social workers all contribute to expediting discharges, cleaning rooms promptly, and expediting rehab referrals, insurance authorizations, and even scheduled ambulances.    


Solving the ED overcrowding crisis isn’t simple, but we can all play a part in mitigating this to improve patient care.  









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.