SHM Converge Scientific Abstract ePoster Gallery-Using Emergency Dept Bed Holds to Optimize Throughput and Identify Opportunities During Periods of High Patient Volume

Pdf Summary

Northwell Health describes a quality-improvement initiative aimed at reducing emergency department overcrowding by using “bed holds” strategically. The project focused on patients already admitted but waiting for inpatient beds in the ED. A daily hospitalist-led multidisciplinary round reviewed these patients in real time to identify those likely to be safely discharged the same day. The team included a hospitalist physician advisor, case managers, advanced practice providers, and nurse managers. When a patient was placed on bed hold, logistics staff were notified not to assign a bed, and testing or review was expedited to support discharge from the ED. A HIPAA-compliant group chat supported daily communication and discussion of updates, including Code 44 utilization review issues.<br /><br />From March to November 2021, 356 bed holds were tracked. Of these, 161 patients (45%) were discharged directly from the ED during the hold period, while 195 (55%) were not. Common diagnoses among successfully discharged patients included chest pain, falls, and musculoskeletal pain. Diagnoses with the highest discharge rates included anemia, psychiatric disposition, and arrhythmia.<br /><br />The initiative showed that physician-led multidisciplinary ED rounds can meaningfully improve throughput, reduce unnecessary bed use, and help relieve overcrowding. It also supports better compliance with Medicare Code 44 review. The main reasons bed holds were unsuccessful included physician discretion, subacute rehab placement processes, and testing-related delays. The team concluded that this approach not only helped discharge patients sooner but also identified opportunities for broader emergency department and inpatient flow improvements.

Asset Subtitle

Jonathan Silver

Meta Tag

Author List Jonathan Silver, Lily L. Yung

Category Innovations

Concept Emergency Department Bed Hold

Concept Patient Throughput

Concept Overcrowding

Concept Multidisciplinary Workflow

Concept Same-Day Admission and Discharge

Distinguished Non-Finalist

Presenter Organization North Shore University Hospital, Northwell Health

Presenting Author Jonathan Silver

Track Transitions of Care

Keywords

Northwell Health

emergency department overcrowding

bed holds

multidisciplinary rounds

hospitalist-led initiative

patient discharge

inpatient bed management

Code 44 review

ED throughput

quality improvement

Emergency Department Bed Hold

Patient Throughput

Overcrowding

Multidisciplinary Workflow

Same-Day Admission and Discharge