Overcrowding in hospital emergency departments is a critical issue with significant impacts on patient care and safety, operational efficiency, and quality of service. The challenge is complex, and requires a collaborative approach by all stakeholders. It is important to define the problem, identify specific and recurrent causes of crowding, and develop strategies to mitigate those problems at a local and national level.
The most common reason for overcrowding is limited ED bed capacity, especially during the pandemic. When a patient is ready to be transferred to an inpatient unit, but there are no beds available, they remain in the ER, taking up space and potentially delaying further treatment. Boarding is a major contributor to overcrowding, and is most often caused by patients requiring screening and stabilization before admitting them to clean wards. These patients are then stationed in ER hallways and annexes, which leads to prolonged wait times for admission or discharge [3].
A number of studies have shown that patients admitted during periods of overcrowding experience increased mortality rates compared to those who were admitted during normal shifts. Overcrowding also contributes to poor outcomes by increasing door-to-needle time, which delays evaluation and drug administration.
Fortunately, the most effective solution to overcrowding involves a comprehensive analysis of both input and output factors. Hospitals need to implement systems to track and analyze their ED volume, as well as clinically relevant data, including sepsis bundle compliance, heart attack and stroke response times, and quality of care metrics. In addition, hospitals need to invest in optimizing throughput (TTP) by streamlining clinical decision-making and hastening the transfer of patients into an appropriate bed. This will result in reducing ED bottlenecks, improving quality metrics, and ultimately driving financial sustainability.