1. Section Editor(s): Laskowski-Jones, Linda MS, APRN, ACNS-BC, CEN, FAWM, FAAN

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What do you expect when you or a loved one needs treatment in an ED? Timely and expert care. It's easy to cast aspersions when delays occur or wait times are long. What's important to appreciate is that the ED is a dynamic system that represents the proverbial canary in the coal mine. It's the place where challenges impacting the healthcare system and the larger community as a whole meld and contribute to the milieu as well as the outcomes.

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ED operations are like an intake and output equation: too much intake without balanced output creates an overload situation, and failure is likely. Imbalances in seemingly unrelated parts of the healthcare continuum can have a profound impact. For example, lack of timely primary or urgent care access in a community can drive more patients to the ED to have unmet health needs addressed. If hospital inpatient length of stay increases due to high patient acuity, system issues, or a lack of enough postacute beds or services in the community to enable timely discharges, hospital occupancy rises. The net result is that newly admitted patients board in the ED while they await inpatient beds.


Having inpatients occupy ED rooms effectively shrinks the size-or functional capacity-of the ED. That same ED now has to care for incoming patients in a much smaller footprint as well as the higher acuity inpatients who haven't left yet. If the ED isn't effectively decompressed, staff workload, ED wait times, and crowding can increase dramatically.


Unlike most other healthcare settings that limit patient census by their bed count or hours of operation, the ED has no cap. Patients of all acuity levels keep coming 24 hours a day, 7 days a week-sometimes in surges-and patients who present for care can't be turned away under federal law.


Addressing issues that cause ED crowding is critical; efficient ED operations are fundamental to a region's emergency preparedness infrastructure. Seemingly small, local actions can make a positive impact. For those who work on an inpatient unit, please support patient safety by developing rapid processes to accept ED admissions without delays. Doing so will make lifesaving rooms more readily available. You never know who might need an ED room next...


Until next time,


Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, FAWM, FAAN

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Editor-in-Chief, Nursing2017 Vice President, Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.