The total number of emergency department (ED) visits in the United States increased 35% between 1995 and 2010, according to the Centers for Disease Control and Prevention. However, according to the American Hospital Association, between 1991 and 2011, the number of hospitals with EDs decreased by 647, leaving less EDs to manage increased visits. These factors contribute to ED crowding, which causes bottlenecks in patient flow and creates patient safety hazards. In 2013, Pennsylvania hospitals reported 23,749 events to the Pennsylvania Patient Safety Authority in which the ED was selected as the care area. Of these reports, 2,495 (10.5%) were submitted as no-harm events requiring monitoring or events resulting in harm or even death for patients being seen during the period between diagnostic testing and disposition decision. This time frame consists of several components, of which most are inputs to the diagnostic process leading to the output of diagnosis and disposition decision. ED measures from the Centers for Medicare and Medicaid Services affect reimbursement. This article is the second in a three-part series that addresses patient safety related to ED flow, and it focuses on strategies to improve processes of care and patient safety during the diagnostic evaluation through disposition decision phase of ED care.
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