#416 2023 · University of Maryland Baltimore Washington Medical Center (Kathy McCollum) · Healthcare / emergency medicinewrong-door
The ER wasn't overcrowded because there weren't enough doctors — it was overcrowded because there weren't enough beds, so the hospital sent the doctors to where the patients already were.
the problem
a system's bottleneck is misdiagnosed as a shortage of the expensive resource everyone assumes is scarce, when the real constraint is a cheaper, differently-scarce resource
background
Emergency departments nationwide, including at University of Maryland Baltimore Washington Medical Center, faced chronic overcrowding commonly diagnosed as a physician or nursing staffing shortage — the standard response across the industry was to try to hire more clinical staff to see patients faster. But adding physicians didn't fix the actual constraint: patients still had to wait for one of a fixed number of treatment beds to open up before any physician could formally assess and treat them, regardless of how many doctors were on shift.
Hospital president Kathy McCollum's team recognized the bottleneck wasn't physician availability at all — it was room inventory. Physicians and advanced practice providers were sitting idle relative to demand not because there weren't enough of them, but because there was nowhere to put a patient for them to actually work, while patients accumulated in the waiting room with no formal care happening.
the move
Rather than continuing to try to add beds or staff to the traditional treatment-bay model, the hospital moved physicians and advanced practice providers directly into the waiting room itself, working from purpose-built rapid-assessment care pods so patients could be diagnosed, treated and released without ever needing a traditional treatment bed at all — treating the waiting room as clinical space rather than a holding area.
the payoff
The hospital's rate of patients who left without being seen dropped significantly after the care-pod model launched, and its EMS ambulance offload times became among the lowest in the state of Maryland, a direct measure of how much faster incoming patients could be handed off rather than queued.
what came after
The waiting-room care-pod model is now cited among hospital operations leaders as an example of correctly diagnosing a capacity bottleneck as a room-inventory problem rather than a staffing problem, and several other health systems have since piloted similar 'provider-in-triage' or front-end assessment models explicitly built on the same room-versus-staff reframing.
references
- [1]Health systems reengineer access to careBecker's Hospital Review, 2023beckershospitalreview.com
- [2]Emergency DepartmentUniversity of Maryland Baltimore Washington Medical Center, 2024umms.org