Factors Associated with Overcrowding and Prolonged Length of Stay in Emergency Department a 3 Year Analysis of a University Hospital (original) (raw)
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Turkish Journal of Emergency Medicine, 2014
Objectives In this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED. Methods We analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined. Results A total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes. Conclusions Similar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio.
Turkish journal of emergency medicine, 2014
Objectives In this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED. Methods We analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined. Results A total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes. Conclusions Similar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio.
Overcrowding in emergency department: an international issue
Internal and Emergency Medicine, 2014
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 4 h of presentation to the ED ('4 h rule') was introduced, 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 hopefully, they may provide valuable contributions in the understanding of ED crowding solutions.
Increase in patient mortality at 10 days associated with emergency department overcrowding
The Medical journal of Australia, 2006
To quantify any relationship between emergency department (ED) overcrowding and 10-day patient mortality. Retrospective stratified cohort analysis of three 48-week periods in a tertiary mixed ED in 2002-2004. Mean "occupancy" (a measure of overcrowding based on number of patients receiving treatment) was calculated for 8-hour shifts and for 12-week periods. The shifts of each type in the highest quartile of occupancy were classified as overcrowded. All presentations of patients (except those arriving by interstate ambulance) during "overcrowded" (OC) shifts and during an equivalent number of "not overcrowded" (NOC) shifts (same shift, weekday and period). In-hospital death of a patient recorded within 10 days of the most recent ED presentation. There were 34 377 OC and 32 231 NOC presentations (736 shifts each); the presenting patients were well matched for age and sex. Mean occupancy was 21.6 on OC shifts and 16.4 on NOC shifts. There were 144 deaths i...
Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions
Journal of Personalized Medicine, 2022
It is certain and established that overcrowding represents one of the main problems that has been affecting global health and the functioning of the healthcare system in the last decades, and this is especially true for the emergency department (ED). Since 1980, overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care. The more recent COVID-19 pandemic contributed to the accentuation of this phenomenon, which was already well known and of international interest. Considering what would appear to be a trivial definition of overcrowding, it may seem simple for the reader to hypothesize solutions for what seems to be one of the most avoidable problems affecting the hospital system. However, proposing solutions to overcrowding, as well as their implementation, cannot be separated from a correct and precise definition of the issue, which must consider the main causes and aggravating factors. In light of the need of finding solutions...
Emergency Department Overcrowding and Its Potential Impact on Care Processes: A Literature Review
International Journal of Advanced Health Science and Technology
Emergency department overcrowding was a obstacle of providing timely and effective care in emergency department. This condition had negatively impact on many aspect of care proccess. There were different finding related to impact of emergency department overcrowding in care process. The aim of the study was to analyze research articles that discusses emergency department overcrowding and its potential impact on care proccess. The study was literature review using database journal resources from PubMed, Proquest, and ScienceDirect. Emergency department (ED), Overcrowding, and impact we used as keyword. Inclusion criteria of the study were original article, Published at 10 years later (2012-2022), written in english language, focus on patient, staff, or health care system level. Whereas, the exclusion criteria were overcrowding because of other condition (endemic or infection disease), and not focus on patient, staff, or health care system. 9 selected articles that met inclusion crit...
Emergency department overcrowding: causes and solutions
Emergency and critical care medicine, 2023
Background Emergency department (ED) overcrowding is among the biggest and most important problems experienced by ED staff. The number of ED visits is on the increase and remains an unresolved problem. Emergency department overcrowding has become an important problem for emergency care services worldwide. There is a relationship between overcrowding and patients’ negative experiences of using ED and therefore reporting reduced patients’ satisfaction. This study aimed to identify the causes of ED overcrowding, determine the reasons for people’s use of EDs, and develop solutions for reducing ED overcrowding. Methods This study used quantitative methods using a descriptive approach. The participants were patients who visited the ED. A questionnaire was administered to 296 participants between December 2021 and February 2022. The study included 5 different hospitals in Turkey. The data were analyzed using descriptive statistics. Results This study identified the most common presenting medical problems in the ED and why patients used the ED. Reasons for using the ED included patients perceiving their condition as really urgent (62.8%), the ED being open for 24 hours (36.1%), and receiving faster care in the ED (31.4%). This study also developed recommendations for alleviating ED overcrowding. Conclusion This study identified causes of ED overcrowding and some solutions for alleviating the issue. Emergency department overcrowding should be perceived as an international problem, and initiatives for solutions should be implemented quickly.
Overcrowding discussion in emergency department (ED) has become a great issue over decade. The EDs plays a significant role as a frontline in hospital which performing good or bad quality of care. Identifying bottleneck relative to patient flow in the ED is one of important factor to determine the quality of care. The EDs can be considered as the heart of the hospital where increasing number of patient in the ED link to the increasing number of patients in the hospital. Therefore performing delivery of care in the ED particularly when its deal with overcrowding could represent the quality of care in hospital as a whole.The study aimed to explore factors related to overcrowding patient and improving emergency patient flow in emergency department. The study was about a literature review and the articlesused in the literature review were full text. The literature review methods were collected and analyzed articles about overcrowding emergency department, emergency department patient flow, the quality of service in emergency room and emergency department performance towards waiting time and length of visit. Articles collected through electronic database, science direct with keywords overcrowding the ED, the ED patient flow, emergency quality services. There were three factors that affect overcrowding patient: prolonged waiting time, triaging, and shortage of doctors and nurses ratio in the ED room. When those three factors are combined, the overcrowding patient in the ED could be handled and it may probably result to improving patient flow. The prolonged waiting time have created delayed of care, patient leaving without being seen/treatment and dissatisfaction among patients The same idea was presented that triaging somehow invent prolonged time especially for those patients in semi-urgent or non-urgent that need treatment between 61 minutes to 2 hours. Those patients are dominantly in the ED and if the patients do not understand triage system they become shorttempered and complaining. The last one was the number of emergency physician and nurses are being backbone of services, however, if it is still lack of number thus leading to troublesome which may significantly affect to effectiveness of care and patient safety. The findings from the abovecited studies suggested that assign fast track for semi-urgent and non-urgent patient should be treated and discharged promptly and properly. Also, expanding the number of physician and nurse staffs with the ratio 1 and 2 respectively as well as developing standardized job descriptions is mandatory. Moreover, extent inpatient bed capacity specifically to critical care unit and increase number of available room for emergency room admission.
A descriptive analysis of Emergency Department overcrowding in a selected hospital in Kigali, Rwanda
African Journal of Emergency Medicine, 2014
Introduction: Emergency Centre (EC) overcrowding is a global concern. It limits timeous access to emergency care, prolongs patient suffering, compromises quality of clinical care, increases staff frustration and chances of exposing staff to patient violence and is linked to unnecessary preventable fatalities. The literature shows that a better understanding of this phenomenon may contribute significantly in coming up with solutions, hence the need to conduct this study in Rwanda. Methods: A quantitative descriptive design, guided by the positivist paradigm, was adopted in this study. Self-administered questionnaires were distributed to 40 nurses working in the EC. Only 38 returned questionnaires, thus making the response rate 95%. Results: The findings revealed that EC overcrowding in Rwanda is characterised by what is considered as reasonable waiting time for a patient to be seen by a physician, full occupancy of beds in the EC, time spent by patients placed in the hallways waiting, and time spent by patients in waiting room before they are attended. Triggers of EC overcrowding were classified into three areas: (a) those associated with community level services; (b) those associated with the emergency centre; (c) those associated with inpatient and emergency centre support services. Discussion: A number of recommendations were made, including the Ministry of Health in Rwanda adopting a collaborative approach in addressing EC overcrowding with emergency trained nurses and doctors playing an active role in coming up with resolutions to this phenomenon; conducting research that will lead to an African region definition of EC overcrowding and solutions best suited for the African context; and increasing the pool of nurses with emergency care training. Introduction: La congestion des services d'urgence (SU) est un enjeu mondial. Celle-ci limite l'acce`s en temps utile aux soins d'urgence, prolonge la souffrance des patients, compromet la qualite´des soins cliniques, augmente la frustration du personnel et les risques d'exposition du personnel a`la violence des patients, et est associe´e a`des de´ce`s e´vitables. D'apre`s la recherche, une meilleure compre´hension de ce phe´nome`ne pourrait dans une large mesure contribuer a`la de´termination de solutions, d'ou`la ne´cessite´d'entreprendre cette e´tude au Rwanda. Me´thodes: Une me´thode descriptive et quantitative, guide´e par le paradigme positiviste, a e´te´adopte´e dans cette e´tude. Des questionnaires auto-administre´s ont e´ted istribue´s a`40 infirmie`res travaillant au sein du SU. Seuls 38 questionnaires ont e´te´retourne´s, d'ou`un taux de re´ponse de 95%. Re´sultats: Les conclusions ont re´ve´le´que la congestion des SU au Rwanda se caracte´risait par ce qui e´tait conside´re´comme un temps d'attente raisonnable avant qu'un patient soit examine´par un me´decin, un taux d'occupation des lits aux SU de 100 pour cent, le temps passe´par les patients qui attendent dans le hall d'entre´e et le temps passe´par les patients en salle d'attente avant d'eˆtre vus. Les causes de la congestion ont e´te´classe´es selon trois cate´gories: (a) les motifs associe´s aux services communautaires; (b) les motifs associe´s au service d'urgences; et (c) les motifs associe´s aux services internes et aux services d'appui au services des urgence. Discussion: Plusieurs recommandations ont e´te´formule´es, notamment l'adoption par le ministe`re de la Sante´rwandais d'une approche collaborative a`la gestion de la congestion, les infirmie`res et me´decins urgentistes qualifie´s jouant un roˆle actif dans la de´termination de re´solutions quant a`ce phe´nome`ne; la re´alisation d'e´tudes qui conduiront a`une de´finition par la re´gion africaine de la congestion des SU et des solutions les mieux adapte´es au contexte africain; et l'augmentation du re´servoir d'infirmie`res forme´es aux soins d'urgence. African relevance Emergency centres in Africa are often overcrowded. Understanding the characteristics of EC overcrowding may generate practical solutions. Policies and guidelines should consider the limited resources in African ECs.