A Full-Capacity Protocol Allows for Increased Emergency Patient Volume and Hospital Admissions

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Our hospital was encountering problems with ED crowding. We sought to determine the impact of implementing a full-capacity protocol to respond to anticipated or actual crowding conditions. Our full-capacity protocol is based on collaboration among multiple hospital units.


We completed a quality improvement initiative using a pre/post analysis of all ED patient encounters after implementing a full-capacity protocol with a corresponding period from the prior year. The principal outcomes measured were patient volume, admission rate, patient left without being seen (LWBS) rate, length of stay, and ambulance diversion hours.


In the post–full-capacity protocol period, a 7.4% increase in emergency patient encounters (P < .001) and an 11.9% increase in admissions (P < .001) were noted compared with the corresponding period in 2013. Also noted in the study period were a 10.2% decrease in LWBS rate (P = .29), an increase in length of stay of 34 minutes (P < .001), and a 92% decrease in ambulance diversion hours (111 fewer hours, P < .001).

Implications for Practice

The collaborative full-capacity protocol was effective in reducing LWBS and ambulance diversion, while accommodating a significant increase in ED volume and increased hospital admission rates at our institution.

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