Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

Abstract

SUMMARYObjectivesIn this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED.MethodsWe analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined.ResultsA total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes.ConclusionsSimilar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio.

Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED

“…Increasing the number of consultant visits to the ED leads to the increasing ED LOS and the ED crowding (2,16,20,22). The most time consume process in consultation is the time arriving of consultant to the ED.…”

Analysis of Triage Application in Emergency Department

“…In a study, it was reported that the patients' average LOS in the emergency department was 183.6 minutes (~three hours) [10]. In another study, avarage LOS in the ED was reported to be 164.1 minutes [2]. For the 900 patients included in the study by Mahmoodian et al revealed that the median waiting time from arrival to first visit by physician was 8 (5 -14) minutes [13].…”

“…Overcrowding is one of the most important problems in the ED which causes decrease in EM popularity. It causes not only motivation disorders of employee but also degradation of the quality of care, increased costs and patients' dissatisfaction [2] [3].…”

“…Besides factors contributing to increased patient volume within the emergency department such as limited physical space and availability of bed space in the intensive care unit, increasing proportions of geriatric individuals in the general population, personnel shortages, delayed consultation with specialists, and delays in imaging and laboratory services, non-urgent patients' use of EDs, rather than primary care settings makes EDs more problematic and chaotic [2] [6].…”

“…The most important cause of bottleneck in the ED seems to be a growing population with non-urgent complaints. Non-urgent patients' use of EDs, rather than primary care settings, allows them to be treated without an appointment in a setting with modern and high-quality technologies [2].…”