Strategies and solutions to alleviate access block and overcrowding in emergency departments

Chan, Sun On; Cheung, Nam Sang; Graham, Colin A.; Rainer, Timothy

doi:10.12809/hkmj144399

Cited by 45 publications

(54 citation statements)

References 41 publications

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“…There are some studies which have examined the issue of ED overcrowding, and suggested many ways to solve the problem [3][4][5], but we did not find, so far, studies that had examined the abrupt change in the ED policy into zero tolerance of boarding patient in the ED, within such a short time. We did not find either its effect on the length of stay (LOS) in GM wards and on ED overcrowding, without changing the number of hospital beds, the staff number, or the inpatient flow to the ED.…”

Section: Introductionmentioning

confidence: 81%

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

Basis¹

2017

J Gen Pract

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Background: Our Emergency Department (ED) went through two periods with different managers. Although the number of beds, visits and admissions during these two periods didn't change significantly, a change in the ED's policy, without a change in the hospital's policy, converted a very crowded ED to an uncrowded one within few weeks, and changed the pattern of work in the hospital, gradually for many years.

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Section: Introductionmentioning

confidence: 81%

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

Basis¹

2017

J Gen Pract

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“…Further, EDs in Hong Kong face many challenges such as access blockages and overcrowding. 29 With the rising level of service demand and competing priorities in EDs, it is important to understand the barriers to better sepsis care from health care providers' perspectives. Our study highlights several challenges.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional study on emergency department management of sepsis

Hung

Lam

et al. 2018

Hong Kong Med J

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“…We do not report on this extensive literature review in this paper, but refer the reader to systematic literature reviews (e.g. Chan et al) [12] and to the discussion section where we included relevant studies supporting the empirical findings.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

Limoges

Gemmel

Landry

et al. 2017

JHA

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Background: One of the root causes of crowding at the Emergency Department (ED) is boarding, i.e. the practice of holding admitted patients in the ED until an inpatient (IP) bed becomes available. Although ED boarding has been approached by various authors, few of them have aimed to see how different hospitals perform in regard to this issue. Objective: This study will approach ED boarding from different angles, analyzing both quantitative and qualitative data, and following both deductive and inductive reasoning. The purpose is to develop a validated integrative conceptual framework which can be used to analyze ED boarding, and to look for solutions. Methods: The development of the framework is based on an extensive literature review and a multiple case study research with both qualitative and quantitative data collection. Results: ED boarding was found to be prominent in the studied hospitals. Four root causes of ED boarding were elucidated, which are: (1) uncoordinated admissions and discharges, (2) late discharges, (3) the inability to discharge patients, and (4) a lack of communication, collaboration, and information between the different actors of the patient care process. Many solutions are proposed to improve these issues. Conclusions: Through the analysis of various types of data, an integrative conceptual framework for ED boarding was elaborated for analyzing causes and seeking solutions. The quantative data cannot only be used in the analysis stage, but can also help in designing a solution as there are clear recognizable trends in arrival, discharge and ED boarding time. "Communication, collaboration and information", although not explicitly discussed in the literature, was found to be the most prominent cause and solution to ED boarding in the field study. Practice implications: Management practitioners now have a framework demonstrating probable causes for ED boarding, which provides a starting point for analysis within their establishments. Pathways to improvement are suggested as well, which will help managers to reduce ED boarding. Communication, collaboration and information are important in these improvement efforts.

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Strategies and solutions to alleviate access block and overcrowding in emergency departments

Cited by 45 publications

References 41 publications

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

Cross-sectional study on emergency department management of sepsis

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

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