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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  27 The limited availability of hospital beds for admitted ER patients is a serious national problem that has numerous negative consequences. At CHC, there were many occasions when half or more of the ER beds were occupied by people who had completed every other step but were waiting for a bed in the hospital. These patients require more routine nursing care, which is a negative consequence in addition to the overcrowding itself. ED nurses aren’t trained as caretakers, and these patients would be better served in a regular room. Bed management also becomes a highly political process, not just in terms of people jumping the line but also with regard to who takes precedence in making a bed assignment. At CHC, they struggle with a primitive bed assignment system, but there are plans in the works to automate this process to make it both fairer and more efficient. Finally, the longer people have to wait for a bed the more likely they will get hungry, and food was not always available for these individuals or for their families. In the course of this study, we observed an attempt by ED management to address the “bed hold” problem (i.e., the number of admitted patients who were still in the ED because no bed was available in the hospital). They designed a program called “Just say yes!” that effectively moved these admitted patients from the ED to the floor so that they could wait up there instead. In theory, this solution makes some sense, in that it relieves crowding in the ED, decreases wait times for new patients, and provides a visible incentive for the floors to prepare a room as quickly as possible. The program lasted only a week,

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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27
The limited availability of hospital beds for admitted ER patients is a
serious national problem that has numerous negative consequences. At CHC,
there were many occasions when half or more of the ER beds were occupied by
people who had completed every other step but were waiting for a bed in the
hospital. These patients require more routine nursing care, which is a negative
consequence in addition to the overcrowding itself. ED nurses aren’t trained as
caretakers, and these patients would be better served in a regular room. Bed
management also becomes a highly political process, not just in terms of people
jumping the line but also with regard to who takes precedence in making a bed
assignment. At CHC, they struggle with a primitive bed assignment system, but
there are plans in the works to automate this process to make it both fairer and
more efficient. Finally, the longer people have to wait for a bed the more likely
they will get hungry, and food was not always available for these individuals or
for their families.
In the course of this study, we observed an attempt by ED management to
address the “bed hold” problem (i.e., the number of admitted patients who were
still in the ED because no bed was available in the hospital). They designed a
program called “Just say yes!” that effectively moved these admitted patients
from the ED to the floor so that they could wait up there instead. In theory, this
solution makes some sense, in that it relieves crowding in the ED, decreases
wait times for new patients, and provides a visible incentive for the floors to
prepare a room as quickly as possible. The program lasted only a week,


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