Emergency departments in medical facilities

Overcrowding continues to pose various issues to emergency departments at medical facilities around the United States and the world (Di Somma et al., 2015). According to an assessment of research data on the delivery of public health, crowding in emergency departments is worsening. Furthermore, they discovered a significant increase in annual emergency department visits between 1995 and 2013. According to Di Somma et al. (2015), the most prominent difficulty highlighted by emergency departments in medical facilities around the world is congestion. The effects have been far from ideal: prolonged waiting times, complaints from patients, demoralized staff, diminished productivity, and even unnecessary deaths just to mention a few (Smith, Bouchoucha and Watt, 2016). It is hence imperative that medical facilities implement changes to at least alleviate the current situation if the public health sector is to it accomplish its mandate of delivering high-quality health services. Out of the numerous interventions possible, the institution of immediate or direct bedding program presents a feasible solution as described hereafter.

Purpose of the program

Foremost, researchers have identified inefficient emergency department procedures as the single-most important determiner of ED throughput. It has also been realized that poor quality of care and the resultant adverse health outcomes increase proportionately with higher levels of ED crowding (Crawford et al., 2014). Therefore, developing and implementing mechanisms to identify bottlenecks that limit the efficient flow of patients in hospitals would seem practicable. Typically, ED activities involved in the front-end processing of patients include procedures such as preliminary patient registration, presentation, triage, bed assignment, and medical checkup. These events are expected to succeed one another to ensure a smooth flow of patients reporting at the reception area hence the interruption of either creates queues resulting in overcrowding (Crawford et al., 2014).

In the context of the above, implementing immediate bedding program would go a long way towards reducing the quantity of non-value-added procedure in the front-end operation of the emergency department. Direct bedding achieves this goal by bypassing all procedures occurring between the time a patient arrives at the medical facility until they are placed in the care room. Direct bedding essentially skips the triage process whose objectives are the identification of the patient, conducting an initial assessment, and making records of the same among others (Flood et al., 2016). By definition, it is deductible that these activities are potential time consumers that would result in delays in case their sequential progression is interrupted.

Target audience

The target audience for the implementation of this program comprises stakeholders in the medical facility ranging from nurse managers, nursing staff, and patients reporting at the emergency department. Nursing managers are particularly relevant stakeholders since they shall be responsible for overseeing the implementation of the immediate bedding program. They shall be in charge of familiarizing the nursing staff and patients of the impending shift from traditional front-end procedures to the direct bedding program. On the other hand, the nursing staff needs to familiarize itself with the proposed program since they the personnel in charge of effecting the new policy. Lastly, patients are an important part of the target audience because their understanding of the changes would ensure a smooth transition and close coordination with nursing staff for the successful implementation of the program.

Benefits of the program

In the immediate bedding program, bedside registration, initial evaluation, and meeting with a medical care provider occur as soon as a patient reports to the emergency department (Flood et al., 2016). Rather than conducting the conventional triage procedures, the primary nurse assesses the patient. Bedside registration then occurs during which the nurse captures and records the patient’s demographic details requisite for the generation of an emergency department chart. Compared to traditional triage procedures, immediate bedding is arguably faster. In fact, the purpose of triage is to determine which reporting patient requires urgent treatment. Direct bedding instead aims to first mitigate the formation of queues without in any way compromising their safety (Houston et al., 2015). The proposed program hence creates the opportunity for rapid admission of patients into the ED. Medical staff hence gain the capacity to order laboratory services and medication during their first meeting with patients. Additionally, immediate bedding has the advantage that all patient processing activities occur parallel to one another rather than after one another. Besides, any additional information can always be solicited from the inpatient (Flood et al., 2016).

In consideration of the challenges arising from poor throughput at the emergency department, immediate bedding has far-reaching benefits. Patients have reported feeling dissatisfied with medical institutions that force them to queue even when the illnesses from which they suffer do not warrant such delays (Loving et al., 2017). Long waiting times have even resulted in confrontations between medical officers and patients being admitted to the emergency department with adverse consequences on the efficient processing of patients at the hospital reception (Loving et al., 2017). Furthermore, poor throughput complicates the work of medical staff who strive to provide quality healthcare in such high-pressure situations. Often, they may inadvertently neglect crucial details such as demographic information essential for desirable patient outcomes. Immediate bedding promises to redress these issues. According to Flood et al. (2016), it has been reported hospitals running the immediate bedding program report higher satisfaction rates among patients who would rather prefer preliminary admission and subsequent release rather than undergoing triage.

Cost and Budget justification

Considering that nurse managers, nursing staff, and patient are not familiar with the proposed program, it is imperative that the program is implemented as a pilot project and involves some training. Also, the hospital has to purchase extra beds to cater for an increased number of admissions. The estimated budget is provided below.

Cost Per Unit ($)

Number of Items

Total Cost ($)

Hospital Bed with Guardrails




Training Medical Staff for Implementation




Total Cost


Evaluation Basis

The foundation for the assessment of the success or failure of this program shall constitute several indicators: patients’ satisfaction, staff satisfaction, and total time spent in the emergency department. Patients are best positioned to provide an accurate assessment of the program, which should ideally be implemented in pilot phases. Patients’ assessment could be gathered by conduction opinion polls to determine the levels of satisfactions. For instance, the surveyor could ask the participating patients to fill open-ended questionnaires expressing their subjective opinion regarding the quality of the quality of health care offered in the emergency department. Similarly, surveys could present close-ended question imploring the respondents to mark the degree to which they were satisfied with emergency department services. The responses could then be tallied to determine the overall percentage level of satisfaction for both patients and nursing staff.


In summary, the sequential nature of traditional front-end procedures renders is disadvantageous to the efficient processing and movement of patients in emergency departments. Disruptions result in unnecessary delays with adverse implications on the delivery of quality health care services, patient and staff satisfaction, and overall productivity at the emergency department. The proposed immediate bedding program hence promises to remediate these challenges by reducing the complexity of the front-end process. A lot of time could be preserved by ensuring that the collection of patient demographics and initial assessments are conducted during the patient’s stay rather than at the time of their admission. While the program promises to be successful, an opinion poll survey could provide an accurate picture of the levels of satisfaction among both patients and staff.


Crawford, K., Morphet, J., Jones, T., Innes, K., Griffiths, D., & Williams, A. (2014).

Initiatives to reduce overcrowding and access block in Australian emergency departments: a literature review. Collegian, 21(4), 359-366.

Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2015).

Overcrowding in emergency department: an international issue. Internal and emergency medicine, 10(2), 171-175.

Flood, R., Szwargulski, P., Qureshi, N., Bixby, M., Laffey, S., Pratt, R., & Gerard, J. (2016).

Immediate Bedding and Patient Satisfaction in a Pediatric Emergency Department. The Journal of emergency medicine, 50(5), 791-798.

Houston, C., Sanchez, L. D., Fischer, C., Volz, K., & Wolfe, R. (2015). Waiting for triage:

unmeasured time in patient flow. Western Journal of Emergency Medicine, 16(1), 39.

Smith, B., Bouchoucha, S., & Watt, E. (2016). ‘Care in a chair’–The impact of an overcrowded

Emergency Department on the time to treatment and length of stay of self-presenting patients with abdominal pain. International emergency nursing, 29, 9-14.

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