The Operational Effectiveness of a Full Capacity Protocol to Ease the Crowding at an Emergency Department
Abstract:
Crowding in the emergency department (ED) has been a significant and growing problem for the hospitals in the United States and around the world. In recent years, the full capacity protocol (FCP), a set of hospital-wide guidelines to alleviate ED crowding, has seen rather wide adoption as an intervention to ease crowding and access block in the ED. Yet, academic literature evaluating its effectiveness is sparse. Using the data from an ED of a large urban teaching hospital in the United States, we seek to fill this gap in literature. An instrumented difference-in-difference approach is applied to investigate the operational effectiveness of the FCP. Comparing the patients who arrived when the FCP was on to those similar visits in absence of FCP, we show that the FCP is effective in reducing patient length of stay (LOS). We also examine the role of laboratory tests during a patient visit, and how laboratory tests affect the patient LOS in presence of the FCP. The FCP can be adopted relatively easily by any hospitals in the sense that it requires minimal capital expenditure for adoptions. Our modeling framework is general enough to handle the idiosyncrasies of different hospitals.