Table 4 Tools and strategies used to manage ED crowding
input | throughput | output | |
|---|---|---|---|
non-critical situation a | − Agreements between specialists of hospital units in the province for urgent hospitalization in the Hub without the patient passing through the ED − Agreements between specialists of hospital units of the Province for consultations in outpatients’ clinics in the Hub without the patient passing through the ED − Structuring of a Provincial supply of outpatients’ clinics for management of patients with urgent priority for examination within 24 h − Direct hospitalization of a patient attending an outpatients’ clinic via coordination with the bed manager, without the patient passing through the ED | − Implementation of the Flow Manager nursing figure − Structural reorganization of ED with creation of two separate areas: high intensity care and/or high healthcare complexity (patients with red, yellow and green tags) and medium/low intensity care and/or medium/low intensity of healthcare complexity (patients with yellow, green and white tags) − Addition of a team (nurse, doctor) dedicated to high intensity care − Installation of an additional CAT dedicated to the ED function − Creation of an info point in the ED for patients and family members | − Implementation of bed management organizational model: structuring of a mixed operation management team to guarantee patient flow − Implementation of case management organizational model: institution of the Case Manager nursing figure in the Medicine Department − Implementation of “Discharge Centre” to assist patients’ return home or accommodation in intermediate care structures (community hospitals, long-term stay structures) |
critical situation b | − The same actions as those activated for non-critical situations | The same actions as those activated for non-critical situations | Activation of additional beds in the hospitalization departments of the Hub |
seriously critical situation c | Strict control of actions activated in “non-critical situations” | − Activation of an additional daytime team (doctor and nurse) in the ED on working days − Partial freezing of activities programmed in the X-ray department to dedicate more diagnostic time to ED activities − Increase in outsourced services (patient and goods transport) | − Activation of further additional hospital beds in the hospitalization departments of the Hub with respect to the critical situation and request for support from Spoke centres − Freezing of programmed hospitalization intake in the Medicine Department − Referral to private structures accredited with the National Health Service in accordance with supply agreements |