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Five strategies to reduce overcrowding in the ED

por John R. Fischer, Senior Reporter | February 24, 2023
Emergency Medicine Pediatrics
The American Academy of Pediatrics has issued a new policy statement with recommendations for reducing crowding in emergency departments.
The American Academy of Pediatrics is calling for greater cooperation among healthcare providers in reducing emergency department crowding, outlining a series of tactics in a new policy statement.

In its “Crowding in the Emergency Department: Challenges and Recommendations for the Care of Children” policy, the AAP Committee on Pediatric Emergency Medicine calls EDs a “safety net for healthcare in many communities,” emphasizing the importance of having them readily available not just for regular emergency care but in “disaster and pandemic cases.”

The primary concern, it says, is patient safety. “This requires a careful, coordinated effort on the part of healthcare systems to improve the flow and care of patients. It also requires helping more young patients access care for chronic conditions in a clinic or other outpatient setting, rather than the emergency department,” said the policy statement’s lead author Dr. Toni Gross.
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Why is crowding a problem to begin with
A primary contributor is boarding, where an admitted patient is held in the ED, typically due to a lack of available staffed inpatient beds.

The problem has been exacerbated this winter by the “tripledemic” surge of influenza, respiratory syncytial virus and COVID-19. Rising mental health challenges among children and teens have also contributed.

Prior research shows that 80% of pediatric ED visits occur in non-children’s hospitals, with a rising number of patients seeking care since before 2022, according to the AAP.

No all-in-one solution
Gross says there is no one approach for avoiding ED crowding, but that hospitals can take steps to reduce it.

AAP recommendations include:

  • Integrating mental health care into primary care pediatrics, including strategies and models for payment
  • Supporting accessible outpatient resources for seeking care, including unscheduled visits and access to subspecialty care
  • Advocating for incentives for extended or non-traditional hours of outpatient service (including weekends), and unique efforts to coordinate care, such as school and community-based programs
  • Extending access to medical care through telemedicine services
  • Encouraging and assisting families with enrollment for healthcare coverage and advocating to reduce barriers to enrollment in healthcare coverage

“It’s also ideal to help families avoid emergency department visits by making it easier for them to access preventive care and manage chronic conditions, including mental health disorders, at an outpatient office,” said Gross.

The policy was published online in February and will be published in the March 2023 Pediatrics issue.

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