Causes and Consequences of Emergency Department Overcrowding; Methods for Resolving it

Abstract

One of the most important parts of the hospital is emergency department which is faced with various problems. One of the most important problems is patients crowding. Overcrowding is a multifactorial and significant variable. Among causes of overcrowding we can mention lack of staffing, structural and demographic causes, and cultural reasons. The consequences of emergency department overcrowding include: reduced level of patient safety, reduced cost benefit and dissatisfaction of the health care system. Multiple manners have been proposed to solve this problem, including the control of ambulances destinations, adding personnel, referring of non-emergency cases, developing primary care units, increasing hospital beds, and expansion of environment in emergency department. But in between, there are simple, effective manners such as regular checking of files by nurses, specialization, and simplification of patients transfer to other wards, which could be administered.

Situation analysis model of hospital emergency department promotion in Iran: A cross‐sectional study

“…Failure to correctly diagnose the doctor, repeating tests and procedures as a result of increasing the patient's waiting time 28,31 …”

“…Valuable Strengths Establishment of triage with trained nurses with the correct distribution of patients, resulting in their timely treatment 30,31 Eliminating additional processes and strengthening the emergency services delivery in the shortest possible time 13,32 Improving the quality of health services delivery to patients 28 Reducing LOS and preventing wastage of valuable financial and human resources 32,33 Having skilled human resources and experienced work 1 The loyalty of employees toward performing their duties in the emergency room 1 Having suitable para-clinical facilities around the clock for emergency patients 1,34 Availability of medical resources available in the ED 1 Weaknesses Increasing acceptance of patients with not-so-serious physical conditions Not leveling emergency triage 33 Inadequate training of personnel regarding the use of new technology, resulting in medical errors 1 Rarity Strengths Removing additional steps in the process of patient transfer from the emergency room to the inpatient wards 34 Using the latest scientific and research resources 20,35 Increasing the presence of specialist doctors in the emergency room and reducing the time to reach the doctor 30 The existence of new portable medical equipment, such as POC(point of care device) devices 1 Providing new treatment methods, such as alternative medicine in the emergency room 27 Providing palliative counseling in the emergency room 31 Weaknesses Overcrowding of visitors to the department emergency 32 Limited financial and human resources 23 Imitability Strengths Increasing accuracy in performing the necessary tests and preventing their repetition 13 Providing unique financial and human resources in the emergency room and provoking competition among other hospitals 8 Implementation of standardized protocols in an emergency 30 Preventing the patient's return by correctly determining the patient's condition in case of discharge from the ED or referral to inpatient departments 30,36 Using the referral system and emergency medicine 20,28,…”

“…The members of the emergency clinical team include (an emergency medicine specialist, resident specialist doctors in the hospital, a general practitioner, emergency nurse) 14,38 2. The members of the emergency clinical team include (an emergency medicine specialist, resident specialist doctors in the hospital, a general practitioner, emergency nurse) 14,38 ED Department heads of the Ministry of Health and heads of involved organizations or other managers of ministries 7,38 Strategic committee 7,8 Emergency doctor and nurse, executive director, head of the emergency nurse, head of ED 38 Hospital emergency service improvement committee 32,39 Members of the project management team led by the Ministry of Health 7 Core team 7,31 F I G U R E 1 Presenting the final situation analysis model of the emergency department.…”

“…Opportunities Existence of supporting laws to increase the budget for emergency analysis 31 Threats Failure to fully implement processes in light of evidence-based medicine 16,22 Non-alignment of performance characteristics and emergency indicators with the goals of the hospital 1…”

“…Increase in the elderly population referring to the ED 30 Increasing patient expectations from emergency services 37 Increasing referrals of patients with sober conditions during the pandemic 34,37 Increasing referrals of patients with different health cultures in conditions of infection transmission 34 Technological factors Opportunities Providing remote emergency services and consultations following technological upgrades 22,28 The existence of reporting systems of emergency indicators at the hospital and national level 27 Threats Non-use of data exchange and registration standards in electronic systems 22 Environmental factors Opportunities Due to the importance of time, considering the appropriate geographical location and easy access to the ED 1 Considering the appropriate physical space and the possibility of expanding new capacities as needed 1 Effective and appropriate communication with the emergency center 38 Proper interaction and communication with the pre-hospital emergency (EMS) (Emergency Medical System) 28,38 Effective communication between medical centers for accepting emergency patients through the medical care monitoring system (MCMC) (Medical Care Monitoring Center) and the Ministry of Health's Treatment Guidance Headquarters 38 Threats Limitation of emergency beds 31 Limitation of physical space during a crisis 1 Lack of specialist staff 3 Limitation of insurance coverage 8 Lack of emergency equipment and medical supplies 3 Failure to pay insurance financial debts and delay in insurance payments to government hospitals 8,22 Failure to increase the defined budget for emergency services and failure to accept certain obligations from insurance 8,33 Failure to collect insurance funds 8,16 Stagnation of the ED following the dissatisfaction of some shareholders and beneficiaries 33 Increasing debt to pharmaceutical companies 8,16 Legal factors…”