Study: hospitals struggle to implement proven strategies for eliminating ED boarding, crowding.

A new study suggests that proven strategies for eliminating boarding and crowding in the ED are being left on the table in many hospitals because leadership has not stepped forward to eliminate pockets of resistance. Further, there is new evidence that changes in practice intensity in the ED are contributing to crowding even though some of these changes were designed to do the opposite. Strategies that can ease crowding include smoothing out the schedule for elective procedures, moving boarded patients up to the hallways on inpatient floors, and appointing a bed czar to oversee bed utilization hospital-wide. Experts say such strategies are difficult to implement because they are hospital-level rather than ED-level problems. A new emphasis on physician satisfaction surveys is driving ED practice intensity along with changes in billing practices and technological innovations.