2. Symposium sponsors:  Mount Sinai Department of Emergency Medicine  Emergency Medicine Associates (EMA)

3. Overview Crowding or Overcrowding?  Need exceeds the resources Multiple contributing factors In put – throughput – out put Consequences  Operational  Logistic  Ethical

4. 2004 70,906 2006 81,981 2008 93,648 Adult35,741 (50%)41,785 (51%)47,460 (51%) Urgent Care11,044 (16%)13,357 (16%)15,276 (16%) Pediatrics24,121 (34%)26,839 (33%)30,912 (33%) Admissions18,881 (26%)19,693 (24%)21,132 (23%) 36% adult 9% peds Emergency Department Census

5. ED Benchmarks: UHC / MSMC MeasureUHC - 2008MSMC 2008 Annual ED visits58,70593,648 Treatment Spaces47 (13 – 81)41 Patients per bed / day3.46.2 Time to see MD110 minutes (median)100 minutes LOS treated and release4.3 hours (median)3.1 hours Patients waiting for a bed7 (median) at 3 pm9 patients at 6 am 20 patients at 8 pm LOS admitted from arrival to leave ED 7.1 hours (median)9.7 hours Time from disposition to bed ready 101 minutes (median)194 minutes Time from bed ready to leave ED 81 minutes (median)146 minutes LWBT / AMA4.6% (median)4.7% Annual hrs diversion1329 hours (0 – 13,361)660 hours

6. 496 - Adult4,1274,740 489 - UC1,2111,269 494 - Psych142115 498 - Peds2,8334,682 Total8,31310,806 JanMay H1N1: Stressing a stressed system

7. Impact of Crowding Quality of Care  Patient satisfaction Increase LWBT / AMA  Attending staff satisfaction  Core Measures  Increases inpatient LOS  Medical errors / Patient safety Increase medical negligence claims Increase deaths