Overcrowding in the Emergency Department

The foundation of delivery of nursing services within healthcare institutions is on various types of theories. Systems theory terminology is one of the theories that view healthcare institutions as social structures that consist of interconnected systems. These systems consist of: inputs, throughputs, outputs, cycles of events, in addition to negative feedback (Meyer & O’Brien-Pallas, 2010). Healthcare institutions are formed by various distinct units which offer numerous diverse levels of care. The emergency department (ED) has specific inputs, throughputs, outputs, series of events and negative feedback. The focus of this paper is on the ED where the department will be analyzed utilizing systems theory to identify a problem in the department and goals, and finally design an appropriate organizational outcome to solve the identified problem in the department Overcrowding in the Emergency Department .

Department Description

The emergency department consists of a 100-bed unit. The department does not have an observation unit and approximately 30% of patients presenting in the department require admission. Nonetheless, the majority of patients have to wait for inpatient beds due to overcrowding. The staffing ratio in the department is 10:1 patient: nurse ratio. The department does not have an adequate quantity of the required basic supplies for an emergency department.

Different subsystems within the emergency department include the staff, materials, as well as the finance required for effective operation of the department (Nahhas et al, 2017). The department is open 24/7 and needs enough staff members, especially nursing staff and ancillary staff to ensure effective provision of throughput of services. Inputs consist of the supplies and materials required for care provision; these materials are procured using various external suppliers. To procure these materials, a healthcare organization should have a specific budget for the emergency department. On the other hand, throughputs are generated when the department uses its inputs to produce a product. Examples of throughput within the emergency department encompass the nursing care services that healthcare providers are supposed to give patients. The output refers to the number of patients the emergency department has the ability to provide care using their inputs (Johnson et al, 2008). Accordingly, the output in the emergency department is what generates revenue after patients pay for the services delivered. The healthcare institution then utilizes the proceeds pre-procure inputs and also finance the emergency department, and hence service and care provision continues (Meyer & O’Brien-Pallas, 2010). Finally, negative feedback is used in establishing the efficiency of the emergency department. The negative feedback is also the performance indicator of the department. The emergency department focuses on numerous performance measures to monitor the department and patient’s throughput, satisfaction of the staff, health outcomes, patient safety, among other measures.

Identified Problem using an Open- Systems Approach

Overcrowding is the problem that has been identified within the emergency department. An analysis of the emergency department in terms of its use of inputs, throughput, output, cycles of events, as well as negative feedback reveals a severe overcrowding as indicated by the treatment delays for seriously ill patients, staff and patient dissatisfaction, ineffective pain management, poor health outcomes, high number of medical errors (Eriksson et al, 2018). Inputs in the ED include nursing staff, materials and require financial operations for the department. There is a shortage of staff members and inadequate materials. This has greatly contributed to overcrowding in the department because due to lack of sufficient nursing staff and materials to provide care to the high number of patients presenting in the department. As aforementioned, throughput refers to aspects such as nursing care services. Due to the shortage of staff members and materials in the department, the provided nursing care services are inadequate and this results to overcrowding. Due to overcrowding, the ED does not have the ability to provide care to the outputs (patients) presenting in the department. For the negative feedback, the overcrowding and long waiting time in the emergency department is an indicator of the department’s inefficiency. In addition, the overcrowding leads to poor health outcomes and patient/staff dissatisfaction, which are additional negative feedbacks in the emergency department (Yarmohammadia et al, 2017) Overcrowding in the Emergency Department .

The Desired Outcome

The desired outcome is that overcrowding in the ED will reduce. There will be adequate staff members, supplies, effective ambulance diversion (input), fast assessment areas and clinical decision units (throughput), and adequate bed-capacity for the patient and full-capacity protocols (outputs). Accordingly, the desired outcome is that the organizational leadership and the emergency department will invest in more nursing staff and adequate supplies to enable effective care provision. It is also required that the leadership and the department will establish more assessment areas and clinical decision units and at the same time increase bed-capacity in the emergency department (Marquis, et al, 2017).

Goals and Objectives to Facilitate Outcome

The goal and objective of the emergency department is to hire and retain more nursing staff and procure adequate supplies in order to ensure good health outcomes, good nurse: patient ratio, increased patient and staff satisfaction, and reduced medical errors in the department. Another goal is to reduce the patient waiting time and to increase the department’s patient capacity.

Policies and Procedures for the Department

The organization and specifically the department should formulate new policies that stipulate staffing ratio, appropriate bed-capacity, waiting time, and the required supplies, resources, and finances for the emergency department.

Relevant Professional Standards

Healthcare organizations are required to implement measures and practices that uphold and maintain both patient and staff safety. Accordingly, ensuring the department has the appropriate staffing ratio, reduced waiting time, required supplies, and adequate bed capacity will ensure provision of safe care to the patients (Nahhas et al, 2017). Additionally, adequate staffing ratio will reduce staff burnout and reduce medical errors and further promote patients and staff safety. Additionally, the state law requires adequate staffing levels in healthcare organizations in order to ensure safety, improve health outcomes, and reduce workload for nurses (Eriksson et al, 2018).

Upholding Mission, Values and Improving the Culture and Climate

The department’s mission and core values include “provision of high quality and safe care to all”. Therefore, for the emergency department to be able to uphold its mission and core values, it is important to eradicate overcrowding in the department. Eradicating overcrowding through adequate staff members, reduced waiting times, adequate bed-capacity, and provision of enough resources for the emergency department will ensure that the department upholds its mission and core values through the delivery of safe and high-quality care (Yarmohammadian et al, 2017). The climate will improve in that there will be an improved patient safety that will ensure patient safety. The department will also strive to endeavor to maintain the culture of safe care delivery Overcrowding in the Emergency Department .


The identified problem is overcrowding in the emergency department. Overcrowding leads to treatment delays, staff/patient dissatisfaction, poor health outcomes, more medical errors, and low-quality care. Therefore, the proposed strategies to improve the situation are to improve the staffing ratio, provide adequate resources, provide adequate bed-capacity and reduce patient waiting times. The desired outcome would be to improve patient safety and care delivery by implementing the proposed strategies. The proposed strategies are supported by professional standards that require the provision of safe and good quality care and the state requirement to have adequate staffing ratios. The leadership both at the organizational and departmental level should be at the frontline in implementing the proposed changes in order to uphold the organizational/department mission and core values.


Eriksson K, Gellerstedt L, Hilleras P & Craftman A. (2018). Registered nurses’ perceptions of safe care in overcrowded emergency departments. J Clin Nurs. 27(5-6):e1061-e1067.

Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Rockville (MD): Agency for Healthcare Research and Quality.

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Meyer, R., & O’Brien-Pallas, L. (2010). Nursing Services Delivery Theory: An Open System Approach. Journal of Advanced Nursing. 66(12), 2828–2838.

Nahhas A, Awald A & Tobias R. (2017). Simulation and the Emergency Department Overcrowding Problem. Procedia Engineering. 178(1), 368-376.

Yarmohammadian M, Rezaei F, Abbas H & Nahid T. (2017). Overcrowding in emergency departments: A review of strategies to decrease future challenges. J Res Med Sci. 22(23) Overcrowding in the Emergency Department .

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