SHM Converge Scientific Abstract ePoster Gallery-Systemwide Level Loading as a Strategy to Reduce Emergency Department Boarding and Improve Hospital Capacity Management.

Pdf Summary

This poster examines whether level loading (LL)—the intentional balancing of patient volume across hospitals in a system—improves emergency department (ED) throughput at INTEGRIS Health Baptist Medical Center in Oklahoma City. Because ED crowding can cause prolonged boarding, delayed admissions, and reduced operational efficiency, the hospital implemented LL with the support of a clinical expeditor (CE), a patient flow coordinator who helps distribute patients across the system.<br /><br />The study was a retrospective before-and-after analysis of hospital performance metrics. Researchers compared ED boarding and throughput outcomes before and after LL implementation, including: the percentage of patients still in the ED more than 2 hours after an admit decision, the percentage with ED stays longer than 280 minutes, mean time from admission order to ED departure, total ED length of stay for admitted patients, transfer refusal trends, and case mix index (CMI). Statistical analysis was performed in SPSS, with p < 0.05 considered significant.<br /><br />After implementing LL with a CE, the hospital saw several improvements: a 7.6% decrease in patients remaining in the ED longer than 2 hours after admission decision; a 7.1% reduction in admitted patients with ED stays over 280 minutes; a 38.5-minute reduction in time from admission order to ED departure; and a 38.5-minute reduction in overall ED length of stay for admitted patients. Transfer refusals also dropped significantly, from a mean of 131 to 84 per month. CMI increased modestly from 2.34 to 2.43, suggesting a trend toward caring for higher-acuity patients.<br /><br />Overall, the findings suggest that level loading improved ED throughput, reduced boarding, enhanced bed utilization, and improved capacity management.

Asset Subtitle

Ahmed Ali Aziz

Meta Tag

Author List Ahmed Ali Aziz, Babak Allahyar, Chelsey Gilbertson, FNU Rabel, Jason Hall, Jonathan Schmitz, Kimberly Williams, Mobolaji Olulade, Tina Malone

Category Innovations

Category Research

Concept Level-Loading

Concept Clinical Expeditor

Concept Patient Flow

Concept ED Throughput

Concept Pre/post intervention study

Distinguished Non-Finalist

Presenter Organization INTEGRIS Health Baptist Medical Center, Oklahoma City, Oklahoma & Oklahoma State University College of Osteopathic Medicine, Stillwater, Oklahoma

Presenting Author Ahmed Ali Aziz

Track Quality Improvement

Keywords

level loading

emergency department throughput

ED boarding

patient flow coordinator

clinical expeditor

hospital capacity management

retrospective analysis

patient volume balancing

admission delay

bed utilization

Level-Loading

Clinical Expeditor

Patient Flow

ED Throughput

Pre/post intervention study