Overcrowding in hospital emergency departments (ED) has become a major issue for health care delivery. It leads to delay of patient care, and it can lead to adverse events such as death. Several interventions can help reduce this problem. However, it is important to recognize that overcrowding is not just an ED issue; it is a systemic problem in the whole hospital, and requires a holistic approach to its resolution.
Hospitals function most efficiently with occupancy levels around 85 percent; beyond that point, it becomes difficult to match patients to areas of care and to free up bed space for new arrivals. This is especially true of unscheduled admissions, which can result in lengthy delays for a patient to leave the ED and be transferred to an appropriate location.
Output factors also contribute to overcrowding, such as failure to transfer patients from the ED after complete treatment, and a tendency to shift low-acuity patients from a medical or surgical ward to an observation unit, where they remain for a longer period of time, increasing the length of their stay. These problems also decrease the staff’s ability to identify early signs of deterioration in these patients and make timely decisions to transfer them back to the ED or for other specialized care.
Studies have shown that hospitals themselves are often the source of overcrowding through self-inflicted practices, such as scheduling that results in peaks of demand, and inadequate triage and discharge processes. These issues can be addressed through a number of strategies, including smoothing the flow of elective admissions, early discharge from the ED and weekend discharges. These changes are safer for patients, easier on staff and more cost-effective for hospitals.
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