Rochester, New York: A decade of emergency department overcrowding

Overcrowding is common in emergency departments (EDs) throughout the United States. The history of ED overcrowding in Rochester, New York, is notable due to its unique health care system that introduced the concepts of manage d care as early as the 1950s. An effect of this system was to intentionally restrict resources and allow the issue of access to limit utilization. Ove rcrowding in EDs was severe in the late 1990s-2000, and became an accepted local standard of care. Objective: To study the strategies to reduce ED ove rcrowding in Rochester in the last decade. Methods: A descriptive analysis of individual hospital and community efforts to decrease ED overcrowding. R esults: Of the strategies tried, those that had little effect on ED overcro wding were based from the ED, such as ambulance diversion. Those that were successful were those that addressed factors external to the ED such as inc reased flexibility of inpatient resources; float nurses who responded to ac ute care needs; a transition team (mid-level provider along with registered nurse (RN)/licensed practical nurse) who cared for inpatients boarded in t he ED; integrated services across affiliated hospitals/systems; an early al ert system that notified key personnel before "code red" criteria were met; and a multidisciplinary team to round in the ED and analyze resource needs . Current community-wide initiatives include precise tracking of code red h ours; monitoring patient length of stay (LOS) in the ED and inpatient units ; education of physicians and nursing homes regarding ED alternatives; expl oration of additional resources for subacute and long-term care; establishi ng a regional forum to address the nursing shortage; development of an ED t riage system to coordinate diversion activities during code red; and consid eration of a county-wide state of emergency when needed. Conclusions: Emerg ency department overcrowding is the end result of a variety of factors that must be addressed system-wide.