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High Reliability Organizations

Transforming the culture, systems and processes of hospitals, health systems and clinicians to ensure safe, equitable care provided each and every time.

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Improving Patient Flow and Reducing Emergency Department Crowding

In 2006 the Institute of Medicine stated that hospital-based emergency care was "at the breaking point." Nine out of 10 hospitals reported boarding admitted patients in the emergency department while awaiting inpatient beds, and nearly half of EDs reported operating at or above capacity. Evidence is mounting that ED crowding compromises care quality.

In the fall of 2008, Urgent Matters, a Robert Wood Johnson Foundation-supported program, launched a learning collaborative designed to assist hospitals as they planned and implemented strategies to improve patient flow and reduce ED crowding. HRET identified six diverse hospitals to participate in the collaborative, and under a contract with the Agency for Healthcare Research and Quality, HRET conducted a comprehensive evaluation of the strategies undertaken.

The evaluation focused on three research questions:

  • What factors motivated, supported or impeded the implementation of the patient flow strategies?
  • What resources were associated with the adoption of the strategies, and what were their associated costs?
  • What changes in patient flow occurred after the implementation of the strategies?

Case studies documenting each hospital's implementation experience may be accessed here:

For more information,  please email (312) 422-3000.

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