Requiem for “Non-Urgent” Patients in the Emergency Department

Hayden, Stephen R.; Jourıles, Nicholas; Rosén, Peter

doi:10.1016/j.jemermed.2009.06.002

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…Patients in our study frequently cited a preference for our institution over other hospitals in the same city. Although ED crowding is reported to be a result of inhibited access to other avenues of care, recent studies have found that the problem is much more complex and actually has little to do with primary care access 20. Our results support the assertion that patients choose to use the ED for a variety of other reasons, namely convenience and reputation.…”

Section: Discussionsupporting

confidence: 81%

“…A widespread effort to expand and vary hours and add flexibility at the offices of general practitioners may have an impact in reducing ED overcrowding. However, such an attempt has been made in the past with no subsequent decrease in ED use 20. Solutions to these issues will include health reform provisions that promote patient-centered medical homes and accountable care organisations, to improve access to primary and acute care 24.…”

Section: Discussionmentioning

confidence: 99%

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Access to care among emergency department patients

et al. 2010

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Access to care among emergency department patients

et al. 2010

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“…However, if health restructures continue (closure of EDs and decreasing inpatient bed capacity), crowding may become more prevalent. Our respondents named several factors they believed to contribute to ED crowding, and their answers were similar to those from other international studies [16-19]: consultation delays, shortages in ED space and beds, admission delays, shortages of acute care inpatient beds, lack of nursing staff, and laboratory and radiology delays.…”

Section: Discussionsupporting

confidence: 67%

Emergency department crowding in The Netherlands: managers’ experiences

Linden

Reijnen

Derlet³

et al. 2013

Int J Emerg Med

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BackgroundIn The Netherlands, the state of emergency department (ED) crowding is unknown. Anecdotal evidence suggests that current ED patients experience a longer length of stay (LOS) compared to some years ago, which is indicative of ED crowding. However, no multicenter studies have been performed to quantify LOS and assess crowding at Dutch EDs. We performed this study to describe the current state of emergency departments in The Netherlands regarding patients’ length of stay and ED nurse managers’ experiences of crowding.MethodsA survey was sent to all 94 ED nurse managers in The Netherlands with questions regarding the type of facility, annual ED census, and patients’ LOS. Additional questions included whether crowding was ever a problem at the particular ED, how often it occurred, which time periods had the worst episodes of crowding, and what measures the particular ED had undertaken to improve patient flow.ResultsSurveys were collected from 63 EDs (67%). Mean annual ED visits were 24,936 (SD ± 9,840); mean LOS for discharged patients was 119 (SD ± 40) min and mean LOS for admitted patients 146 (SD ± 49) min. Consultation delays, laboratory and radiology delays, and hospital bed shortages for patients needing admission were the most cited reasons for crowding. Admitted patients had a longer LOS because of delays in obtaining inpatient beds. Thirty-nine of 57 respondents (68%) reported that crowding occurred several times a week or even daily, mostly between 12:00 and 20:00. Measures taken by hospitals to manage crowding included placing patients in hallways and using fasttrack with treatment of patients by trained nurse practitioners.ConclusionsDespite a relatively short LOS, frequent crowding appears to be a nationwide problem according to Dutch ED nurse managers, with 68% of them reporting that crowding occurred several times a week or even daily. Consultations delays, laboratory and radiology delays, and hospital bed shortage for patients needing admission were believed to be the most important factors contributing to ED crowding.

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“…Previous studies have analysed this phenomenon and investigated what events bring patients to the ED. These suggestions have, however, not been supported by a number of studies [5,[10][11][12]. These suggestions have, however, not been supported by a number of studies [5,[10][11][12].…”

Section: Introductionmentioning

confidence: 88%