Delaying of healthcare for economic reasons is causing volatility in hospital emergency room volumes that is expected to intensify. To handle staffing, equipment and treatment challenges posed by these census variations, hospital EDs must rethink processes and protocols. At Edward Hospital in Naperville, Il., a "culture of certification" that includes cash bonuses for certification and peer support during exam preparation helps to raise the caliber of the ER staff and maintain patient satisfaction levels. Cindy Rentsch, Edward Hospital's clinical director of emergency services, describes the culture of certification that has raised the caliber of Edward's ER staff, a marketing campaign to divert mental health patients from the ER and protocols for treatment of pediatric ER patients. Rentsch is joined by Joan Heater, director of nursing emergency services, Banner Gateway Medical Center and Kevin Roche, director of the management engineering program at Banner Health Corporation, during Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time, a January 14, 2009 webinar. The three presenters shared organizational strategies that improve throughput in the ER as well as increase efficiencies, reduce costs and improve patient outcomes and satisfaction.