Effect of Emergency Department Crowding on Outcomes of Admitted Patients

Purpose
Emergency department (ED) crowding is a significant patient safety concern associated with poor quality of care. The purpose of this systematic review is to assess the relationship between ED crowding and patient outcomes.

Design
We searched the Medline search engine and relevant emergency medicine and nursing journals for studies published in the past decade that pertained to ED crowding and the following patient outcome measures: mortality, morbidity, patient satisfaction, and leaving the ED without being seen. All articles were appraised for study quality.

Findings
A total of 196 abstracts were screened and 11 articles met inclusion criteria. Three of the eleven studies reported a significant positive relationship between ED crowding and mortality either among patients admitted to the hospital or discharged home. Five studies reported that ED crowding is associated with higher rates of patients leaving the ED without being seen. Measures of ED crowding varied across studies.

Conclusions
ED crowding is a major patient safety concern associated with poor patient outcomes. Interventions and policies are needed to address this significant problem.

Clinical Relevance
This review details the negative patient outcomes associated with ED crowding. Study results are relevant to medical professionals and those that seek care in the ED.

/pdf/the-relationship-between-emergency-department-crowding-and-116t5b2i0y.pdf

The relationship between emergency department crowding and patient outcomes: a systematic review.

Overcrowding in the emergency department (ED) has become an increasingly significant worldwide public health problem in the last decade. It is a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, as for example it occurs in mass casualty incidents, but also in other conditions causing a shortage of hospital beds. In Italy in the last 12-15 years, there has been a huge increase in the activity of the ED, and several possible interventions, with specific organizational procedures, have been proposed. In 2004 in the United Kingdom, the rule that 98 % of ED patients should be seen and then admitted or discharged within 4ho f presentation to the ED ('4 hr ule') was intro- duced, and it has been shown to be very effective in decreasing ED crowding, and has led to the development of further acute care clinical indicators. This manuscript represents a synopsis of the lectures on overcrowding problems in the ED of the Third Italian GREAT Network Congress, held in Rome, 15-19 October 2012, and hope- fully, they may provide valuable contributions in the understanding of ED crowding solutions.

/pdf/overcrowding-in-emergency-department-an-international-issue-3r2pm5eh6b.pdf

Overcrowding in emergency department: an international issue

One key factor contributing to emergency department (ED) overcrowding is prolonged waiting time for admission to inpatient wards, also known as ED boarding time. To gain insights into reducing this waiting time, we study operations in the inpatient wards and their interface with the ED. We focus on understanding the effect of inpatient discharge policies and other operational policies on the time-of-day waiting time performance, such as the fraction of patients waiting longer than six hours in the ED before being admitted. Based on an empirical study at a Singaporean hospital, we propose a novel stochastic processing network with the following characteristics to model inpatient operations: (1) A patient’s service time in the inpatient wards depends on that patient’s admission and discharge times and length of stay. The service times capture a two-time-scale phenomenon and are not independent and identically distributed. (2) Pre- and post-allocation delays model the extra amount of waiting caused by second...

/pdf/models-and-insights-for-hospital-inpatient-operations-time-26k6x05vb7.pdf

Models and Insights for Hospital Inpatient Operations: Time-Dependent ED Boarding Time

Debriefing in the Emergency Department After Clinical Events: A Practical Guide

The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom The authors are local emergency care leaders with knowledge of emergency care in their particular countries Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED ED crowding appears to be worsening in many countries despite the presence of universal health coverage Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1553-2712.2011.01235.x

Santiago Ferrandiz

Papers

International perspectives on emergency department crowding.