Children's Hospitals Today - Summer 2023 - 29

EMERGENCY CARE / FEATURE
OUTPUT
Finally, output is how-and how
quickly-patients
transition out of
the ED. A primary driver of crowding
here is boarding-or holding an admitted
patient in the ED-typically due to
a lack of available staffed inpatient
beds. Boarding has been exacerbated
by the increasing number of patients
coming to the ED for mental or behavioral
crises, who may be boarded until
they can move to a bed or another facility
as needed.
Boarding is an all-too-familiar scenario
for Timm, Lane and Gross. " It's the
biggest driver of our ED crowding problem, "
Gross says. " That could potentially
be because all of the beds are used up
or because there's not enough nursing
staff to open all of the beds. " Children's
Hospital New Orleans has a 46-bed
emergency department; two are resuscitation
beds and eight are reserved
strictly for behavioral health patients.
Yet, Gross says, for the last year and a
half, not all 46 beds have been staffed
due to the lingering nursing shortage
brought on by the pandemic.
A more obscure disruption caused
by the behavioral health crisis is the
complexity
of medical
clearance,
which is required to get patients out
of the ED. Patients who present with a
physical condition, like a broken arm,
may be seen for a mental condition,
like suicidal ideation, before they are
medically cleared, which creates potential
confusion in the system about
when the patient is truly cleared for
transfer or discharge. The time it
takes to resolve the issue extends
length of stay and reduces the availability
of beds.
Beyond staff shortages and the
behavioral health crisis, inpatient
delays occur for a variety of reasons.
According to the AAP technical report,
these include complexity of care, lack
of outpatient availability, prolonged
length of stay, or lack of system coordination,
to name a few.
The bottom line
ED crowding is such a complex problem
that solutions require coordinated
efforts across the health care delivery
system. The key to all of it, according
to Gross, is an organization-wide perspective
of health care delivery. " The
biggest recommendation I have is to
remember that this is a hospital issue,
not an emergency department issue, "
she says. " Any conversations, whether
around brainstorming or making hard
decisions, need to include multiple departments
within the hospital. "
" ED crowding is not something that
emergency departments can solve on
their own, " adds Timm. " This really requires
all hands on deck. "
Megan McDonnell Busenbark is a
writer and content strategist based
in Omaha, Nebraska.
Send questions or comments to
magazine@childrenshospitals.org.
SOLUTIONS
How patients leave the ED
ENSURE parallel processing
to speed admission and lower
length of stay.
ADOPT capacity alert systems to
help enlist additional resources
when needed.
CREATE a dedicated observation
unit that admits unscheduled
patients from the ED.
OPEN play areas or family waiting
rooms for patients waiting for
discharge to free up beds faster.
OFFER a " bridge clinic " for
patients who need intensive
services but can be safely
discharged from the ED before
meeting with a behavioral
health provider.
DEVELOP an in-home care
program for behavioral health
patients after discharge,
connecting them with clinician,
therapeutic and peer caregiver
support services.
SEEK funding from or
partnerships with local and state
agencies to develop solutions.
UTILIZE reverse triage to
determine which inpatients can
be discharged or transferred to a
lower level of care.
CHILDREN'S HOSPITALS TODAY Summer 2023
29
Children's Hospitals Today - Summer 2023

Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2023
