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Emergency department overcrowding

Analysis and strategies to manage an international phenomenon

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Summary

Overcrowding in emergency departments is a common and worldwide phenomenon, which is widely reported even in the lay press. Strategies to address this incriminating situation for patients, nurses, physicians and hospital administrators are urgently needed. The current review presents an analysis of the overcrowding problem as well as strategies to answer overcrowding situations.

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References

  1. Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: a review of strategies to decrease future challenges. J Res Med Sci. 2017;22:23.

    Article  Google Scholar 

  2. Australasian College for Emergency Medicine. Statement on emergency department overcrowding. Melbourne: Australasian College for Emergency Medicine; 2011. p. 57.

    Google Scholar 

  3. Vilpert S. Konsultationen in Schweizer Notfallstationen. Neuchâtel: Schweizerisches Gesundheitsobservatorium (Obsan); 2013. pp. 1033–303.

    Google Scholar 

  4. Shenvi CL, Platts-Mills TF. Managing the elderly emergency department patient. Ann Emerg Med. 2019;73(3):302–7.

    Article  Google Scholar 

  5. Müller M, Khamis D, Srivastava D, Exadaktylos AK, Pfortmueller CA. Understanding refugees’ health. Semin Neurol. 2018;38(2):152–62.

    Article  Google Scholar 

  6. Hostettler S, Kraft E. FMH-Ärztestatistik 2018. Schweiz Arzteztg. 2019;100(12):411–6.

    Google Scholar 

  7. Institute of Medicine Committee on the Future of Emergency Care in the U.S. Health System. The future of emergency care in the United States health system. Ann Emerg Med. 2006;48(2):115–20.

    Article  Google Scholar 

  8. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–36. https://doi.org/10.1016/j.annemergmed.2008.03.014.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Howard MS, Davis BA, Anderson C, Cherry D, Koller P, Shelton D. Patients’ perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding. J Emerg Nurs. 2005;31(5):429–35.

    Article  Google Scholar 

  10. Huang JA, Tsai WC, Chen YC, Hu WH, Yang DY. Factors associated with frequent use of emergency services in a medical center. J Formos Med Assoc. 2003;102(4):222–8.

    PubMed  Google Scholar 

  11. Schull MJ, Mamdani MM, Fang J. Influenza and emergency department utilization by elders. Acad Emerg Med. 2005;12(4):338–44.

    Article  Google Scholar 

  12. Muscatello DJ, Bein KJ, Dinh MM. Emergency Department demand associated with seasonal influenza, 2010 through 2014, New South Wales, Australia. Western Pac Surveill Response J. 2017;8(3):11–20. https://doi.org/10.5365/wpsar.2017.8.2.002.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lambe S, Washington DL, Fink A, Laouri M, Liu H, Scura Fosse J, et al. Waiting times in California’s emergency departments. Ann Emerg Med. 2003;41(1):35–44.

    Article  Google Scholar 

  14. Polevoi SK, Quinn JV, Kramer NR. Factors associated with patients who leave without being seen. Acad Emerg Med. 2005;12(3):232–6.

    Article  Google Scholar 

  15. Cooke MW, Wilson S, Halsall J, Roalfe A. Total time in English accident and emergency departments is related to bed occupancy. Emerg Med J. 2004;21(5):575–6.

    Article  CAS  Google Scholar 

  16. Kyriacou DN, Ricketts V, Dyne PL, McCollough MD, Talan DA. A 5‑year time study analysis of emergency department patient care efficiency. Ann Emerg Med. 1999;34(3):326–35.

    Article  CAS  Google Scholar 

  17. Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. J Am Med Assoc. 1991;266(8):1085–90.

    Article  CAS  Google Scholar 

  18. Bindman AB, Grumbach K, Keane D, Rauch L, Luce JM. Consequences of queuing for care at a public hospital emergency department. J Am Med Assoc. 1991;266(8):1091–6.

    Article  CAS  Google Scholar 

  19. Rowe BH, Channan P, Bullard M, Blitz S, Saunders LD, Rosychuk RJ, et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med. 2006;13(8):848–52.

    Article  Google Scholar 

  20. Liu S, Hobgood C, Brice JH. Impact of critical bed status on emergency department patient flow and overcrowding. Acad Emerg Med. 2003;10(4):382–5.

    Article  Google Scholar 

  21. Schull MJ, Vermeulen M, Slaughter G, Morrison L, Daly P. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004;44(6):577–85.

    Article  Google Scholar 

  22. Hwang U, Richardson LD, Sonuyi TO, Morrison RS. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc. 2006;54(2):270–5.

    Article  Google Scholar 

  23. Peltan ID, Bledsoe JR, Oniki TA, Sorensen J, Jephson AR, Allen TL, et al. Emergency department crowding is associated with delayed antibiotics for sepsis. Ann Emerg Med. 2019;73(4):345–55. https://doi.org/10.1016/j.annemergmed.2018.10.007.

    Article  PubMed  Google Scholar 

  24. Sikka R, Mehta S, Kaucky C, Kulstad EB. ED crowding is associated with an increased time to pneumonia treatment. Am J Emerg Med. 2010;28(7):809–12. https://doi.org/10.1016/j.ajem.2009.06.023.

    Article  PubMed  Google Scholar 

  25. Miró O, Antonio MT, Jiménez S, De Dios A, Sánchez M, Borrás A, et al. Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med. 1999;6(2):105–7.

    Article  Google Scholar 

  26. Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184(5):213–6.

    Article  Google Scholar 

  27. Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006;184(5):208–12.

    Article  Google Scholar 

  28. Crook HD, Taylor DM, Pallant JF, Cameron PA. Workplace factors leading to planned reduction of clinical work among emergency physicians. Emerg Med Australas. 2004;16(1):28–34.

    PubMed  Google Scholar 

  29. Oredsson S, Jonsson H, Rognes J, Lind L, Göransson KE, Ehrenberg A, et al. A systematic review of triage-related interventions to improve patient flow in emergency departments. Scand J Trauma Resusc Emerg Med. 2011;19:43. https://doi.org/10.1186/1757-7241-19-43.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ming T, Lai A, Lau PM. Can team triage improve patient flow in the emergency department? A systematic review and meta-analysis. Adv Emerg Nurs J. 2016;38(3):233–50. https://doi.org/10.1097/TME.0000000000000113.

    Article  PubMed  Google Scholar 

  31. Burström L, Nordberg M, Ornung G, Castrén M, Wiklund T, Engström ML, et al. Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models. Scand J Trauma Resusc Emerg Med. 2012;20:57. https://doi.org/10.1186/1757-7241-20-57.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Singer AJ, Taylor M, LeBlanc D, Meyers K, Perez K, Thode HC Jr, et al. Early point-of-care testing at triage reduces care time in stable adult emergency department patients. J Emerg Med. 2018;55(2):172–8. https://doi.org/10.1016/j.jemermed.2018.04.061.

    Article  PubMed  Google Scholar 

  33. Jang JY, Shin SD, Lee EJ, Park CB, Song KJ, Singer AJ. Use of a comprehensive metabolic panel point-of-care test to reduce length of stay in the emergency department: a randomized controlled trial. Ann Emerg Med. 2013;61(2):145–51. https://doi.org/10.1016/j.annemergmed.2012.07.021.

    Article  PubMed  Google Scholar 

  34. Kankaanpää M, Raitakari M, Muukkonen L, Gustafsson S, Heitto M, Palomäki A, et al. Use of point-of-care testing and early assessment model reduces length of stay for ambulatory patients in an emergency department. Scand J Trauma Resusc Emerg Med. 2016;18;24(1):125.

    Article  Google Scholar 

  35. Singer AJ, Williams J, Taylor M, Le Blanc D, Thode HC Jr. Comprehensive bedside point of care testing in critical ED patients: a before and after study. Am J Emerg Med. 2015;33(6):776–80. https://doi.org/10.1016/j.ajem.2015.03.034.

    Article  PubMed  Google Scholar 

  36. Dagar S, Sahin S, Yilmaz Y, Durak U. Emergency department during long public holidays. Turk J Emerg Med. 2016;14(4):165–71.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland

    Gregor Lindner M.D. &  Bertram K. Woitok M.D.

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  1. Gregor Lindner M.D.
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Correspondence to Bertram K. Woitok M.D..

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G. Lindner and B.K. Woitok declare that they have no competing interests.

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GL study concept, GL and BW were responsible for the literature search and the manuscript draft.

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Lindner, G., Woitok, B.K. Emergency department overcrowding. Wien Klin Wochenschr 133, 229–233 (2021). https://doi.org/10.1007/s00508-019-01596-7

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