ABSTRACT
The interval within the emergency department (ED), the disposition-to-departure, presents special challenges with respect to improving flow. Although difficult to improve, it is one of the most important determinants of ED performance. A good hospital administrator will continually try to reduce the number of human resources required to run the hospital efficiently, staffing as few inpatient beds as possible, pushing bed utilization higher. A great way to inspire movement in people organization is to quantify the financial impact of walkouts and diversions. Several hospitals have tried successfully to push patients upstairs in a process known as full-capacity protocol. This concept, promoted by Peter Viccellio, involves pushing patients upstairs and parking them in hallway beds on individual wards. Most community hospitals can easily target 1 hour from the decision to admit to leaving the department. This is because there are very few handoffs, phone calls, and evaluations that need to occur before the patient can be moved upstairs.
