1. Moran-Peters, Judith RN, DNSc
  2. Sadowski, JoEllen RN, MS, NE-C

Article Content

Problem to be Resolved:

Emergency department (ED) overcrowding is a national epidemic that threatens public health by compromising patient safety. The Joint Commission requires that hospitals develop processes to eliminate ED overcrowding. Nevertheless, little information is available describing effective, evidence-based nursing practices that decrease overcrowding, create a climate of safety, and improve quality outcomes in the ED environment.


Objectives of the Project:

The aim was to describe how information technology (IT) and innovative nursing practices can be used to decrease overcrowding and improve outcomes in the ED.



To decrease overcrowding and improve quality outcomes in the ED, the Center for Nursing at Huntington Hospital developed innovative, evidence-based nursing practices. The cornerstone of these practices was a change in culture to "zero tolerance" for admitted patients being held in the ED. Other key practices included the following: (1) implementation of a hospital-wide, electronic patient tracking board (Horizon Enterprise Visibility Indicators) to improve communication among caregivers and movement of patients throughout the hospital; (2) appointment of an "RN patient flow coordinator"; and (3) development of an IT-based "ED Capacity Management" protocol to deploy additional nursing and support staff as the ED census increases.



The use of the hospital-wide IT systems and innovative, evidence-based nursing process has resulted in significant decreases in ED overcrowding, improved patient and staff satisfaction, fewer errors and delays in treatment, and fewer patient/family complaints.


Lessons Learned:

Overcrowding in the ED and the overall quality of care provided to ED patients can be significantly improved through the use of IT and innovative, evidence-based nursing practices. First, however, a hospital-wide culture of zero tolerance for holding admitted patients in the ED must be developed to consistently achieve high-quality outcomes.


Section Description

We are pleased to share the paper presentation abstracts from the Summer Institute in Nursing Informatics, Informatics at the Point of Care: A Barrier or a Bridge?, held at the University of Maryland School of Nursing, July 22 to 25, 2009. The program, chaired by Dr Judy Ozbolt, was a great success. Each of the following abstracts was selected for presentation by a peer-review committee.