Overcrowding is a global healthcare issue and has been linked to adverse patient outcomes. It determines an increase in the risk and rate of complications, even death. In addition, it reduces the quality of care delivered to patients. This article focuses on the root causes of hospital overcrowding and describes effective strategies that have been used to address them.
The authors conducted a literature review and identified the major factors contributing to overcrowding in the emergency department (ED). The most significant causes of hospital overcrowding include: a lack of ED inpatient beds; unnecessary visits caused by a breakdown of standard procedures; poor and uninsured patients lacking primary care; safety net issues such as the use of community health centers; and seasonal illnesses. Insufficient ED staff and a lack of physician consults are also important factors. Moreover, inadequate flow of patients through the ED results in patients staying in a crowded ED longer than necessary for the management of their illness, which is known as boarding. In addition, uneven elective surgical scheduling contributes to a high level of ED occupancy. Efforts to smooth elective surgery scheduling can lead to a better balance between the demands of the ED and inpatient beds, as well as improve efficiency on all units. As a result, the author concludes that effective solutions to overcrowding require multiple actions, including acknowledging the problem and providing visible committed leadership. This, along with a data-driven approach and coordination between all departments from housekeepers to the CEO, can reduce crowding in EDs.