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

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Presentation transcript:

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

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

, , ,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

ED Benchmarks: UHC / MSMC MeasureUHC MSMC 2008 Annual ED visits58,70593,648 Treatment Spaces47 (13 – 81)41 Patients per bed / day 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

496 - Adult4,1274, UC1,2111, Psych Peds2,8334,682 Total8,31310,806 JanMay H1N1: Stressing a stressed system

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