nursing interventions can play a central role in preventing the overcrowding of the ED



Implementation Plan


Identifying a Target Population

Hospital emergency departments (ED) continuously face the problem of limited resources, increased patient presentation, aging population, and shortage of healthcare providers. Most EDs have, therefore, become among the most overcrowded sections of any healthcare facility. They are characterized by long waiting time that contributes negatively to the patients’ outcome as well as low family experiences. However, ideal nursing interventions can play a central role in preventing the overcrowding of the ED.

Problem Statement

Although hospitals have been striving to cut the cost, this goal has not been satisfactorily addressed because of the challenge of patients returning to emergency departments. Most hospitals have been focusing on reducing 30-day readmission with several initiatives and interventions. In the US, it is estimated that 28% of the acute care visit and 50% of the hospital admissions arise from ED (Rising et al., 2014). The enactment of Patient Protection and Affordable Care Act and has demonstrated the need for integrating patient care voice in designing the delivery of healthcare. The explanations for patients to return to the ED, the possibility of future return, and the repeated return can be examined from the administrative data. Some common factors have been associated with high rates of readmission of patients to ED. They include low follow up care and language barrier that limits patients from understanding the discharge instructions. Other factors can be old age, no ambulatory status, and lack of family support.

Proposed Clinical Intervention

The proposed intervention is to utilize the expertise of nurses in minimizing overcrowding in the ED. These professionals are at an ideal position of reducing the congestion because they are in direct contact with patients. They, therefore, have specialized tasks, which are the root causes of overcrowding. The problem of the patients to understand discharge instructions can be addressed adequately by nurses (Sayah et al., 2014). They handle all the necessary procedures of ensuring that patients are discharged from the hospital, which includes all the paperwork that needs to be illustrated to the patients, their caregivers, or family members. Nurses can take this opportunity to explain in detail all the questions that the patients of caregivers ask and even asking them questions to ensure that they understand the provided information in detail. They can also take the initiative of confirming the transportation of the patients from the ED to their destination, especially when using the ambulatory services. Nurses are in better positions of discussing in detail all the concerns of the patients as well as their illnesses. This intervention can ensure that patients adhere to all the directives of the care providers to avoid instances such as wrong medication. It should be reinforced with proper ED training on the management of patients to avert future returns. Intensive training can focus on enhancing the role of nurses and integrating patient engagement. The effort can ensure that patients do not go to the ED again and, consequently, reducing overcrowding.

The contribution of nurses in the ED can also be manifested in developing discharge checklists before releasing patients from the hospital. This can ensure that all the expectations and requirements are fully addressed, and the patients are cleared. Precise follow-up should be deployed to ensure that patients are faring as expected and that they are not experiencing challenges with medications. With the advancement in modern healthcare, technologies like telemedicine can be used to maintain the connections between patients and nurses. These approaches can promote contact between the two parties and ensure that patients can reach the nurses without necessarily visiting the ED.

The long term intervention of nurses in minimizing the problem of overcrowding should focus on creating an ED-based care program that incorporates the care teams in ED management. The approach can also be in the form of training on a range of factors. They include the prevention of return cases. Nurses have a role of fostering evidence-based practice that can be instrumental in mitigating the problems of overcrowding in ED (Sayah et al., 2014). Most nursing concepts are based on training and evidence, which implies that the professional can design evidence-based practices to explore the problem from a scientific perspective. Such an approach will allow the nurses to shift from the traditional paradigm of clinical practice in ED to clinical expertise that is founded on scientific evidence, values, and preferences of patients.

Analysis of the Target Population

The study population is adults in the US. They have varying cultural backgrounds, which are mainly determined by race. Among the cultural aspects that prevail in American society can be categorized into whites, African-American, Hispanic, Asians, Native Americans, and people with a combination of two races. The culture of the target population impacts their health, beliefs about diseases and death, lifestyles as well as health promotion. The psychosocial dimensions include can be categorized into three. Medical dimensions relate to the type of treatment, the perception of suffering, and the clinical course. Psychological factors cover the disruption of life goals and the potential of adjusting life plans using coping strategies and emotional stability. The social factors comprise the availability of support from close associates such as friends, family, and co-workers.

The environmental factors for the target population are significant in influencing the quality of their health and defining the necessary preventive measures. It is estimated that 23% of all deaths in the world, as well as 26% of deaths in children below the age of 5, are contributed by environmental factors that can be prevented (Healthy People 2020, 2019). Some of the factors that impact the target population include climate change, exposure to toxins in food, water, air and soil, the contamination of their habitats, and occupational dangers.

The estimated demographic descriptors of the population are 49.1% male and 50.9% female and a median age of 35 for both genders. The population has an average family size of 3.14. The health literacy of the target population varies significantly according to race. For example, 14% of the whites are proficiency in health literacy; the rate literacy rate for Hispanics is 4%, with that of the African American being only 2% (Rikard et al., 2016). The intermediate literacy rate for the three races is 58%, 31%, and 41 %, respectively. The proficiency level implies that individuals can clear read, write, understand, and solve problems. The intermediate level suggests that people can experience a problem, such as solving problems. Health literacy has direct impacts on health outcomes. Literate people have better outcomes than illiterate ones. In 2016, the life expectancy of the target population was 78.8 (Rikard et al., 2016). Diabetes and stroke caused 21.3 and 37.6% of all deaths in this population. The adults that smoke cigarette makes 15.1% of the entire population. It is further estimated that 21.8% of the people visit the emergency room at least once a year.

Literature Support and the Clinical Problem

The US and the global healthcare system have been experiencing a rapid increase in the demand for ED. This has been resulting in overcrowding of these rooms. Numerous studies have confirmed that between 2001 and 2008 ED returns were considerably high, and more than 50% of the patients recorded multiple visits each year (Ericksen & Kocher, 2019). Out of these patients, more than 1% had visited the ED more than five times and amounted to 18% of all the visits. The Centers for Disease Control estimates that the US healthcare system records 145.6 million ED visits and return visits of at least 12.6 million each year (2017).  In 2014, about 5.7% of the ED visits involved patients that had been admitted before in the last three days.

Strategy for Implementation of the Clinical Interventions

The implementation strategy will be a classroom presentation and training of the appropriate ways for discharging patients. It will also include learning the discharge checklist that will be provided to patients at the time of their discharge, and which they have to check the mark boxes of what they understood. They then need to sign upon understanding and then return to the nurse after the education session. The expected outcome and evaluation strategy will be determined by the extent to which the patients understand the instructions. The effectiveness of this intervention will be manifested in the improvement of service delivery in the ED. The strategy is expected to reduce the overcrowding at the ED and improvement of the patient outcome.







Centers for Disease Control and Prevention. (2017). Emergency department visits. Retrieved from

Ericksen, G, M & Kocher, K. (2019). Trends in emergency department use by rural and urban populations in the United State. Retrieved from

Healthy People 2020. (2019). Environmental health. Retrieved from

Rikard, V. R, Thompson, S. M, McKinney, J & Beauchamp, A. (2016). Examining health literacy disparities in the United State: A third look at the National Assessment of Adult Literacy (NAAL). Retrieved from

Rising, L. k, Padrez, A, B’Brien, M, Hollander. E. J Carr, G. B & Shea, A. J. (2014). Return visits to the emergency department: The patient perspective. Retrieved from

Sayah, A, Rogers, L, Devarajan, K, Rocker, K. L & Lobon, F, L. (2014). Minimizing ED waiting times and improving patient flow and experience of care. Retrieved from