Access Block and Emergency Department Overcrowding

Two emergency departments, 6000 km apart: Differences in patient flow and staff perceptions about crowding

“…ED crowding is defined as a state where care demands exceed available resources, 48 resulting in long waits for tests and treatments [2][3][4]. Crowding is a major barrier to receiving timely 49 emergency care and it contributes to poor quality care, such as prolonged waiting times, increased 50 suffering for those in pain, poor clinical outcomes, delays in treatment and increased risks of adverse 51 outcomes [5][6][7][8][9][10].…”

“…At AKUH, LOS increases simultaneously with acuity. Prolonged LOS is one of the 284 throughput-causes of ED crowding [3]. 285 AKUH staff perceived that crowding could be reduced by more efficient ED processes and by 286 increased capacity within the hospital.…”

Triage at the Emergency Department: association between triage levels and patient outcome

“…In developing countries, including Brazil, this problem becomes even more serious because emergency services represent the main access route to the health care system (1)(2)(3) . Previous studies have shown that overcrowding leads to increased health costs, decreased efficiency and quality of care, and increased incidence of adverse events and mortality, all of which culminate in poor performance of the health care system (4)(5)(6)(7) . To prioritize health care for severely ill patients, hospitals have instituted triage systems in recent decades with the aim of identifying patients with more severe conditions and with increased risk of death, thereby ensuring faster service with minimal waiting time (1,(8)(9)(10)(11)(12) .…”

Outlier admissions of medical patients: prognostic implications of outlying patients. The experience of the Hospital of Mestre

“…Hospitals with mean occupancy rates over 90% have the greatest risk of providing inadequate care for users, [8][9][10] and hospital wards cannot run at around 100% occupancy for long without increasing patients' clinical risks. 7,11 Conversely, an occupancy index around 85% would give an optimal balance between care efficiency and safety.…”