Systems Opportunities to Reduce ED Crowding From Nonemergency Referrals

Am J Med Qual. Jan/Feb 2018;33(1):37-42. doi: 10.1177/1062860617700721. Epub 2017 Mar 22.


Emergency department (ED) crowding threatens patient safety and is associated with increased mortality. This study explored the role of nonurgent referrals to the ED in crowding and collaborated on a large quality initiative with the study institution's accountable care organization (ACO) to provide timely alternatives to such referrals. Fifty-two percent of nonemergent ED patients report contacting a medical provider prior to coming to the ED, with 70% of those providers directing the patient to go to the ED. Fifty-nine percent of patients indicated that they would have accepted a clinic appointment in lieu of going to the ED. The authors collaborated on a multidisciplinary ED alternatives quality improvement effort with leadership to address these nonemergent referrals. ED visits per 1000 ACO patients declined significantly following survey results and ACO implementation of increased alternative ambulatory resources.

Keywords: accountable care organization; crowding; emergency department; nonurgent visits.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accountable Care Organizations / statistics & numerical data
  • Ambulatory Care Facilities / statistics & numerical data*
  • Crowding*
  • Emergency Service, Hospital / statistics & numerical data*
  • Health Services Accessibility
  • Humans
  • Interdisciplinary Communication
  • Leadership
  • Medicaid / statistics & numerical data
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Quality Improvement / organization & administration
  • Referral and Consultation
  • United States