Causes of Emergency Department Overcrowding and Blockage of Access to Critical Services in Beijing: A 2-Year Study

Abstract

One principal reason for ED crowding in Beijing lies in the large numbers of patients who persist in the expectation of receiving ongoing care in the ED for minor illnesses. However, as is true in many nations, one of the other most important root causes of ED crowding is "access block," the inability to promptly move patients deemed by emergency physicians to need inpatient care to an inpatient bed for that care. However, in our system, another challenge, not widely described as a contributor to crowding in other nations, is that doctors assigned to inpatient services have been empowered to refuse to admit patients perceived to have overly "complex" needs. Further, patients with multisystem illnesses or end-stage status, who need ongoing chronic care to manage activities of daily living, have begun to populate Beijing EDs in increasing numbers. This is an issue with various root causes.

The impact of the COVID-19 pandemic on the emergency department visits: a retrospective analysis in Shanghai, China

“…China has a large population, and ED overcrowding is widespread in many big cities and has reportedly reached crisis proportions [11,12]. In China, the most common conditions seen in the ED were acute bronchitis, acute pharyngitis, Sprains and strains, super cial injury and contusion, which are usually not so urgent and don't need emergency-based services.…”

Older adults are prioritized in terms of waiting time under the emergency triage system in Guangzhou, China

“…A registry clerk then collects data, such as sex and date of birth. Much like the situation in Beijing, emergency admission is difficult because of an inpatient bed shortage, after each ED encounter provided by the attending physician, doctors assign patients with unstable conditions with an emergency observation status, waiting for an improvement or hospitalization …”

“…Much like the situation in Beijing, emergency admission is difficult because of an inpatient bed shortage, after each ED encounter provided by the attending physician, doctors assign patients with unstable conditions with an emergency observation status, waiting for an improvement or hospitalization. 13 We included all individuals aged ≥14 years who visited the ED of the Third Affiliated Hospital of Sun Yat-sen University between 1 August 2015 and 31 December 2017. Exclusion criteria were as follows: (i) obstetrics and gynecology emergency treatment; (ii) incomplete triage records; (iii) leaving without being seen (no diagnosis); (iv) level I patients (treated immediately on arrival); and (v) an excessive waiting time (after the first 4 exclusions, the waiting time exceeded the 99th percentile of patients, which was ≥187 min).…”

Saturación y hacinamiento del servicio de emergencia de un hospital urbano

“…Las causas se pueden agrupar en etapas pre, intra y posterior al propio servicio de emergencia. Entre los factores preemergencia, destaca la consulta inadecuada con reportes de hasta 70% siendo sus causas más frecuentes iniciativa (o decisión) propia del paciente, no citas en atención primaria y falta de medicamentos (5,10) .…”

“…Los principales factores intraemergencia que influyen en el hacinamiento son: demora en la atención inicial (funcionamiento de triaje hospitalario), demora en ayuda diagnóstica, administración de tratamiento o disponibilidad de camillas de observación. Los factores postemergencia incluyen la disponibilidad de camas en pisos hospitalarios, otros hospitales y transporte para transferencia de pacientes (10) .…”