Hospital overcrowding has become a chronic issue affecting patient outcomes, hospital finances and workforce sustainability. The causes and aggravating factors are many. ED overcrowding is not just a flu season or mass casualty event issue; it has become the result of structural and operational problems that impact hospital EDs across all shifts.
A number of studies show the connection between ED overcrowding and poor outcomes, both in terms of length of stay and admission rate to the hospital. Boarding is a major factor in the overcrowding phenomenon and is directly related to exit block and bed availability. In fact, boarding is an indication that health care providers have not been able to discharge patients from the ED after providing them with appropriate and timely medical consultations and diagnostic workups because of the lack of inpatient beds.
The long wait times experienced by overcrowded EDs lead to people leaving without being seen by a physician, and this reduces overall ED throughput. Those who remain are less likely to be screened for signs of deterioration, so they are at higher risk of complications and adverse events. In addition, they may be more likely to require subsequent admission and hospitalization, and in some cases they are even at higher risk of death.
Various strategies can improve flow and capacity in the emergency department, including optimizing patient triage, increasing staffing levels, streamlining ambulatory care, improving hospital operations and planning, and enhancing ED capacity. However, even small changes to a hospital’s physical structure are often cost prohibitive because they must go through a gauntlet of lengthy state reviews and approvals.
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