The operational effectiveness of a full capacity protocol to ease crowding at an emergency department

Abstract Using detailed timestamp data for patient visits and laboratory test orders from the emergency department (ED) of a large, urban, teaching hospital in the United States, we examine the operational effectiveness of the full capacity protocol (FCP), a set of temporary hospital‐wide guidelines that seek to alleviate crowding at the ED. We use an instrumented difference‐in‐differences approach and construct a comparable treatment group prior to the introduction of the FCP. Our results indicate that the FCP is effective in reducing the patient length of stay (LOS) when activated. Patients who arrived when the FCP was activated experienced an estimated reduction in LOS of 6.23%. This reduction was achieved through shorter waiting and after‐treatment times. The reduction in after‐treatment time helped expedite access to the treatment area for waiting patients, alleviating the bottleneck and improving the throughput, consistent with the theory of swift even flow and the theory of constraints. We also find an inverted‐U‐shaped relationship between boarding census and after‐treatment time when the FCP was on, a pattern not observed under similar crowding levels when the FCP was not on.