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November 15, 2001
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Hopkins' Emergency Extended Care Unit Reduces Overcrowding

–Walk-out rate drops by more than 50 percent

Researchers at Johns Hopkins have found a possible solution to the nationwide crisis of overcrowding in hospital emergency departments. By opening a 14-bed acute care unit, where patients can be managed for up to 72 hours before being discharged or formally admitted to the hospital, the Hopkins Emergency Department (ED) is better equipped to handle more patients.

"Within the first two months of operation, the daily percentage of patients who tired of waiting and left without being seen dropped from a worrisome 10 percent to a little under 4 percent," says Gabor D. Kelen, M.D., professor and chair of emergency medicine. "In addition, the amount of time we've had to be on ambulance diversion, when we couldn't take any more patients, has plunged more than 40 percent. During the time of comparison, other nearby hospitals have increased their number of diversion hours by 44 percent."

The greatest decrease in walkouts occurred during the midnight to 8 a.m. shift, from 20.6 percent to 8.9 percent. During the evening shift of 4 p.m. to midnight, walkouts dropped from 17.7 percent to 8.2 percent. These results are noted in the November issue of the journal Academic Emergency Medicine.

Nationwide, hospital emergency departments have felt the crunch of additional patients. More than 45 million uninsured use the ED in place of a primary care health provider, and nursing shortages and community hospital closings have contributed to the problem. About 55,000 patients visit the Hopkins ED each year.

The Hopkins acute care unit, which opened in January, has 14 beds, three treatment rooms, a waiting room and a nurses station and was placed in existing hospital space, with renovation costs of approximately $550,000. About 1,589 patients were seen in the unit during the first 10 weeks of operation, representing about 14.5 percent of the ED volume. Thirty-three percent were treated in the main ED and sent to the extended care unit for further evaluation and management, 20 percent were held in the unit until a hospital bed became available, and the rest received treatment in the unit. Thirty-two percent of patients seen in the unit ultimately were admitted to the hospital.

"Many administrators feel that any extensions of space must be adjacent to the ED or on a ground floor," Kelen says. "While that's ideal, in our case, the only available space was a few hallways away and six floors up. It's worked very well, and at a much lower cost than new construction."

An added bonus, he says, has been a significant improvement in patient satisfaction scores: "Surveys have shown us that when patients are on this unit, they don't even realize they're in an ED."

The ED also added a seven-bed urgent care center for treatment of less serious ailments in April 2000. The main ED has 22 beds, two procedure rooms and two critical care bays.

Other authors of the article were James J. Scheulen, M.B.A., and Peter M. Hill, M.D.

Kelen, G.D., et al., "Effect of an Emergency Department (ED) Managed Acute Care Unit on ED Overcrowding and Emergency Medical Services Diversion," Academic Emergency Medicine, Vol. 8, No. 11.

Related Web Sites:
Johns Hopkins' Department of Emergency Medicine

Society for Academic Emergency Medicine

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