Emergency Room Overcrowding Essay

PICOT Question

In emergency room overcrowding (P), can stationing an advanced practice provider/team triage model (I), reduce the overcrowding (O), when compared to stationing an RN only triage (C)?

Problem/Population: P

Intervention: I

Comparison: C

Outcome: O

Time: T (Optional)

Evidence-Based Solution

The proposed intervention is to station the advanced practice provider/team at the triage, during times when there is high patient inflow. This intervention aims to reduce overcrowding at the ER. The busiest times in the hospital will be identified, and the team members at the triage will be assigned specific tasks to undertake at the triage (Burstrom et al., 2016). The triage provider will perform a medical screening examination and order diagnostic tests for patients presenting to the ED. There will also be a rapid assessment team consisting of a nurse and advanced nurse practice/physician. A team approach at the triage has been shown to reduce overcrowding at the ED and improve patient satisfaction (Burstrom et al., 2016).

Nursing Intervention

The nurse at the triage will be responsible for assessing patients, taking vital signs, prioritizing patients, and determining their level of need for medical care. The nurse will work in collaboration with other healthcare providers (advanced nurse practitioner/physician) to initiate the appropriate treatments and administer medications and treatments as prescribed by the advanced nurse practitioner/physician.

Patient Care

The aim of patient care is to improve health outcomes and effective management of patients at the triage is among the important elements of patient care. Overcrowding in the ED is an obstacle to the provision of high-quality care (Davenport et al., 2017). Overcrowding in the ED leads to delayed treatment and in turn, affects patients in different ways. For example, delay to administer analgesics leads to significant suffering to the patient having severe pain, while delays in treatments such thrombolytic medications and aspirin or antibiotic administration may lead to severe deterioration of health status and increase mortality rate in patients with heart conditions and community-acquired pneumonia respectively (Begaz et al., 2016).


Health Care Agency

The proposed change will be implemented in the emergency department in my current healthcare organization. The organization provides emergency care services, primary care services, maternity services, orthopedics, pediatric care, among other healthcare services. The change will be implemented in the ED.

Nursing Practice

Stakeholders likely to be impacted by addressing overcrowding at the ED include the nurses, physicians, advanced nurse practitioners, laboratory technicians, and patients. Reducing overcrowding at the ED is key to promoting better patient outcomes. Addressing and reducing overcrowding is thus an effective measure to improve the quality of care, patient safety, and positive health outcomes (Davenport et al., 2017). Evidence shows that reducing overcrowding at the ED reduces waiting times for the patients; reduces the length of stay in the hospital, prevents heath deterioration, reduces the mortality rate, improves care outcomes, and improves patient satisfaction (Begaz et al., 2016). With the increased need for EBP, the findings from the proposed capstone project are expected to improve nursing practice (Burstrom et al., 2016). Additionally, findings from the proposed project may be generalized and applied in other EDs at different healthcare organizations.


Begaz, T., MD, Elashoff, D., Grogan, T. R., MS, Talan, D., MD, & Taira, Breena R., MD, MPH. (2016; 2017). Initiating diagnostic studies on patients with abdominal pain in the waiting room decreases time spent in an emergency department bed: A Randomized controlled trial. Annals of Emergency Medicine, 69(3), 298-307.

Burstrom, L., Engstrom, M., Castren, M., Wiklund, T., & Enlund, M. (2016). Improved quality and efficiency after the introduction of physician-led team triage in an emergency department. UPSALA Journal of Medical Science, 121(1), 38-44.

Davenport, P. J., O’Conner, S. J., Szychowsky, J. M., Landry, A. Y., & Hernandez, R. (2017). The relationship between emergency department wait times and inpatient satisfaction. Health Marketing Quarterly, 34(2), 97-112.


PICOT Question Paper

Topic – Emergency Room Overcrowding

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

  1. Evidence-based solution
  2. Nursing intervention
  3. Patient care
  4. Health care agency
  5. Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide, An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.



  • A PICOT question is presented and provides a clear framework for the capstone project change proposal.
  • A nursing intervention used to address the problem is clearly presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are thoroughly discussed.
  • The clinical problem and how it can result in a positive patient outcome are thoroughly discussed. Strong rationale is offered for support.
  • The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is described. Some minor detail is needed for clarity.
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