How a Crowded Emergency Department Became Non-crowded and Crowded Back within 10 Years: Is It an ED Leadership Failure or a Hospital Leadership Failure, or Maybe Both?

Background: from 1993 until 2013 our Emergency Department (ED) went through three periods, with
different ED manager each. Although the number of beds, visits and admissions during these three
periods didn't change significantly, a change in the ED’s policy, without a change in the hospital’s
policy, converted a very crowded ED to a non-crowded one within few weeks. However, a change in
the ED policy and that of the hospital management policy rendered a non-crowded ED an
overcrowded one back within, 6 months.
Objectives: to describe how we rendered a very crowded ED into a non-crowded one within few
weeks, to try to explain why it turned back to become crowded again, and to suggest some advice
from our experience.
Methods: It is an epidemiolocal cross-sectional retrospective study. all data about the ED and other
departments activities were collected by our hospital’s computerized business intelligence (BI)
system.Because of lack of some data, the study includes 3 equal periods: period “A”, period “B” and
period “C”(1997 -2001, 2001-2006 and 2007-2011 respectively). For statistical comparison of
averages of the different periods, we used the unpaired student T-test.
Results:The average length of stay (LOS) of patients in the ED during period "A", was 5.05 + 0.98
hrs. It dropped to 2.45 + 0.21 during period "B" (P< 0.001).The percent of patients boarding in the ED
more than 10 hours dropped from 11.5 + 2.4% (period “A”) to 2.6 + 0.7% (period “B”) within three
months (P< 0.01). Despite a gradual increase in the number of admissions to the GMD`s, there was a
gradual decrease in the average LOS during period "B", compared to period "A" (6.1 vs. 5.5 days) (P<
0. 5). The death rate among patients in the ED and in the GMD`s decreased significantly during the
period "B" (P< 0.1). During period "C", after both the CEO and the ED manager retired, all these
changes were reversed within a few months.
Conclusions:Rendering a crowded ED into non-crowded, needs the assertiveness of the ED
Managers in implementing their policy, with the personal full backing of the hospital CEO, as a must
condition before managing the ED.