EDs Look to Hospitalists to Solve Crowding


GRAPEVINE, Texas–ED crowding may not seem like the hospitalist's purview, but an HM leader speaking at HM11 says think again.

Boarding, the term for admitted patients who are held in the ED, makes the issue particularly relevant to HM, says Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center's HM division.

"Almost everyone is equating boarding of admitted patients now with ED crowding," says Dr. Howell, an SHM board member. "And who do you think they're going to come to for help with all the boarded patients? They're going to come to you."

Dr. Howell says that although HM leaders might think of bed management mostly as a discharge issue, hospitalists would be well served to work with their respective ED colleagues to manage emergency throughput better. He suggests two initial approaches:

1. Round on boarders. In some practices, including at Johns Hopkins Bayview, a hospitalist can be dedicated to the practice of seeing admitted patients held in the ED. If a dedicated staffer is unavailable, group members can rotate the service.

2. Add capacity. Virtual capacity can be added by initiatives that lower LOS and therefore effectively create more bed space. Capacity can be added physically via something as ambitious as the creation of a unit, or techniques as simple as placing admitted patients in hallways.

"Targeting the ED alone doesn’t work," Dr. Howell says. "Patients boarding in the ED needs to be solved. … People are looking for good hospitalists to solve the problem."

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