A recent survey conducted by Greater New York Hospital Association (GNYHA) of its member hospitals identified myriad issues that have an impact on patient flow through the emergency department (ED). As ED volume in New York continues to increase (see Figure 1), hospitals are being challenged to absorb additional patients and manage their flow through the ED in order to minimize "bottlenecks" and increase the efficient use of limited resources. Among the findings of the survey are:

• Hospitals with automated tracking systems, which can assist in measuring and identifying patterns and trends that have an impact on effective patient flow, reported more success in monitoring the flow of patients through the ED.
• Insufficient bed availability—in particular, critical care beds—is a primary impediment to efficient patient flow through the ED (see Figure 2).
• A shortage of ED nurses and ancillary support staff, and inadequate laboratory and turnaround time, were also reported as impediments in some hospitals.

GNYHA is continuing to work on ED patient flow issues and will use the results of this survey to identify system gaps, best practices, advocacy needs, and educational opportunities on behalf of member hospitals.