Other emergency rooms are revamping treatment areas to relieve backlogs. The ER at Vanderbilt University Hospital in Nashville, for example, acts as the region’s Level 1 trauma center. In recent years, the daily volume in the 46-bed ER has soared to as many as 200 patients, says emergency medicine chairman Corey Slovis. Worried that someone would die before treatment, Slovis set up a triage team, including a physician and nurse who sort arriving patients according to the urgency of their needs. The hospital launched this team-triage approach in 2005 and spent about $150,000 to create five small exam areas in which noncritically ill patients can be assessed and given blood tests, X-rays and other evaluations.

Staffed from 11 a.m. until 11 p.m., the triage area has proved ideal for patients who come in with routine sprains, flu and other easily treatable conditions. “Not every patient needs an ER bed, but team triage helps us make sure the sickest people receive care without delay,” Slovis says. On very busy days, the triage team may treat 30 patients who can be discharged without moving on to the ER. But increased efficiency comes at a price. “The cost of an additional ER physician alone can average $150 to $200 an hour,” says Schneider, formerly of Strong Memorial, which tested and then decided against physician-led triage, mostly because of the additional strain it put on the hospital budget.

Technology, too, can play a role in relieving gridlock. The MGH and the hospital at the University of Pennsylvania, among others, have purchased tele-tracking devices designed to monitor the status of patient beds. Icons, color codes and text displayed on screens can tell the ER and other departments where patients are, how long they’ve been there and whether they’re being moved to another part of the hospital.

“But these systems are only as good as the data that’s entered,” says the University of Pennsylvania’s Pines, who notes that there are often problems during shift changes, when staff members are busy with paperwork and other tasks. “Even if housekeeping cleans an empty bed and it’s ready for a new admission, unless someone enters the data into the system, the bed is effectively in use,” Pines says. “So we still end up waiting hours to transfer an ER patient to an inpatient bed.”

One solution that some hospitals have tried is to crown a “bed czar,” usually a nurse, whose chief responsibility is monitoring patient flow and helping to eliminate delays. Another is to discharge patients early in the day to open up beds. But that can be difficult to coordinate, and family members often can’t take patients home until after work. Some hospitals, including William Beaumont, have created discharge lounges, comfortably furnished areas in which stable patients can wait to be picked up and get prescriptions filled.

Surgical smoothing may sound like some kind of cosmetic procedure, but it’s actually an innovative method for addressing ER overcrowding. It was pioneered at Boston Medical Center, New England’s largest Level 1 trauma center, which treats more than 132,000 ER patients annually. Eugene Litvak, who heads Boston University’s Health Policy Institute, has studied the flow of patients in and out of hospitals and brought a simple concept to the project. Because emergency rooms compete with surgical admissions for inpatient beds—and because elective surgery tends to be scheduled for the first few days of each week—why not look for ways to smooth out peaks and valleys in the overall schedule to create a more predictable flow of patients?