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September 5, 2018

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Virtual Capacity Innovations Reduce Emergency Room Overcrowding

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National emergency department (ED) overcrowding has continued to grow over the past couple of decades alongside economic, regulatory and public pressures to provide expeditious service, reduce wait times and delays and meet quality benchmarks. This growth in overcrowding demands innovative solutions to better optimize ED patient flow.


Prevailing conditions have led to the development of ED patient flow management maneuvers that:

  • Enable a saturated ED to provide medical evaluation, treatment and disposition of patients during episodes when patient flow would otherwise have come to a stop, with arriving patients being triaged and placed into “waiting” status in the lobby until space is available.
  • Can be implemented along with—or independent of—best practice flow prototypes, such as Split Flow and Team Triage, that target reduction of door-to-medical provider time and the number of patients who leave prior to medical screening examination.
  • Move front-end and overall length-of-stay metrics in a positive direction.
  • Enable under-bedded EDs to provide expeditious service without undertaking expensive construction projects


Virtual Capacity

Virtual capacity employs parallel processing of patients with several being in process simultaneously rather than one at a time using traditional sequential (linear) flow. In short, virtual capacity tactics enable EDs to move low-to-moderate-acuity patients through their systems without using beds. The benefits to be gained through virtual capacity are therefore greatest for space-constrained departments.

ED boarding of admitted inpatients has had a significant negative impact on the number of beds available to patients presenting to EDs across the country. Boarding is not being overlooked or dismissed among the list of causative factors for ED overcrowding. Virtual capacity, however, is comprised of processes that reside entirely within an ED’s operational control and is more readily amenable to implementation.

Virtual capacity is comprised of the following concepts:

  1. Keep vertical patients vertical and moving. For horizontal patients, location is the focus, but for vertical patients, speed of throughput matters most.
  2. Vertical patients do not own beds. This is also referred to as the “no parking” approach to patient flow.
  3. Internal results-pending areas provide infrastructure for virtual capacity.
  4. Occupancy limits for intake and treatment rooms minimize throughput time for patients who are in process and wait times for those yet to be evaluated and treated.