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Management research to provide operational advice on improving quality, reducing costs and eliminating disparities.

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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 report boarding admitted patients in the emergency department (ED) while they await inpatient beds, and nearly half of EDs report 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 plan and implement strategies to improve patient flow and reduce ED crowding. The Health Research & Educational Trust (HRET) identified six diverse hospitals to participate in the collaborative, and under a contract with the Agency for Healthcare Research and Quality (AHRQ), HRET is conducting a comprehensive evaluation of the strategies undertaken.

The evaluation is 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:

To learn more about this project, contact Steve Hines at (312) 422-2607 or

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