Emergency Department Overcrowding

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an

Any patient brought into the Emergency Department, is first signed in at ED receptionist desk and triaged by a triage nurse, prioritized and brought to patient room by a charged nurse either by wheelchair or stretcher or walking by the patient depending on patient’s illness. A nurse is assigned to the patient. Emergency Doctor comes in and if the patient illness is life threatening it is stabilized and the Doctor orders test such as blood work and x-ray if necessary to be conducted. Based on the test result the patient is either discharged or admitted. Certain times the emergency department is filled with a lot of patient that there is no place to sit and patients keep coming in and creating

Francis, M., Rich, T., Williamson, T., & Peterson, D. (2010). Effect of an emergency department

In 2000, the Department of Health(DH), set a range of emergency care access targets in its NHS plan, and in 2001 the government published Reforming emergency care   (DH, 2001) which established waiting time targets for all UK emergency care patient contacts;. The new standard was introduced into the NHS in England in 2002; stating that 98% of patients presenting to ED’s would be seen, treated, admitted or discharged within four hours of arrival by 2004, no one was to wait more than four hours in an ED (from arrival to admission to a bed, transfer elsewhere or discharge). Whilst the author agrees that it has improved the overall for the patient’s experience within the ED. It must be borne in mind that before the decision ‘to come into’ hospital (TCI), that the patient receives the correct clinical decisions prior to TCI.

Assess the current Models of Care in their Emergency Departments using the given criteria It is recognised that not all of the Models of Emergency Care are applicable for all NSW Emergency Departments. Decisions to implement them will be made based on the staff, patient presentations and space available in the ED to operate each model. Assess the potential to introduce models to their hospitals that may improve patient care and flow, the patient experience and clinical outcomes

The role of the emergency department is to diagnose and treat acute and urgent illnesses and injuries. Patients are seen in order of medical urgency. The emergency department bases the patients urgency for treatment based on levels. Level 1 is critical and life-threatening. This is usually related to ABC’s (Airway, Breathing, and Circulation). These patients are top priority and require a lifesaving intervention. Level 2 is also considered high priority and can also be life-threatening. Psychiatric patients are considered level 2, and patients arriving to the ED with chest pain. Level 3 patients require resources such as sutures, x-rays, CAT scans, MRI, etc. Level 3 patients are provided treatment services only after Level 1 and 2 have been addressed. The emergency department at CEMC also has a trauma room and a SANE room. The trauma room is equipped with life-saving medications (such as antidotes for drug overdose) and medical equipment. The SANE (Sexual Assault Nurse Examiner) room consists of equipment used to assess a patient who has been sexually assaulted. The equipment takes pictures of the patient for the SANE nurse to later provide to law enforcement. A SANE nurse is a specialty nurse and CEMC has one on call 24/7.

Emergency department (ED) overcrowding has become an international health crisis and been identified as a major threaten to public health. As defined by Australasian College for Emergency Medicine, overcrowding is a situation in which ED patients’ demand for services exceeds the staffing capacity to provide care within a reasonable length of time, thereby impeding ED function. Some has called ED as the safety net of the health care system, given its unique role in public health. However, the increasing problem of crowding and the associated impacts has strained this safety net to the “breaking point”. ED overcrowding and prolonged waiting time are associate with adverse consequences towards quality of care and patient safety, as well as

The presence of Emergency Department (ED) crowding, and long boarding times, hinders its ability to provide the quality and efficient care (Weiss, Rogers, Maas, Ernst, & Nick, 2014). According to Mullins and Pines (2014), an average patient in the United States spends more than 4 hours in the ED before being admitted to an inpatient unit. ED crowding and increased boarding time have negatively impacted bed availability, increased staff workload, decreased productivity, and lessened patient satisfaction. Many healthcare organizations, including the Veterans Health Administration (VHA), have established an electronic bed board system (BMS) and InterQual Level of Care Criteria (IQLCC), which aim to enhance patient flow within organizations (United States, 2013).

There are are multiple consequences of visiting the emergency department for non-urgent needs. Moskop (2010) identified overcrowding, expensive care, and suggested lower quality of care. The consequences seemed to be universally consistent with varying descriptions. For example, Boyle (2015) identifying long wait times as a consequence but this is an effect of

Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007.  JAMA 2010; 304: 664-670

to meet the demand of overwhelming patient volume. A study of the impact of this practice is published in The American Journal of Emergency Medicine 2012 issue. It concluded that the selective usage of nontraditional beds to accommodate patients with specific complaints can be an effective way to improve the patient flow in the emergency department (McNaughton et al., 2012). Patients that are ill or injured can be placed in the hallways, conference rooms, or anywhere appropriate if neither life-threatening nor non-emergent emergency is present. Granted that mentally-ill patients are not always suitable to be situated in hallways, overcrowding makes it difficult at times. As a matter of fact, the triage prioritizes patients with medical problem more than psychiatric patients. As published in the Emergency Severity Index triage system by the Agency for Health Quality Research, patients who are in psychological distress will only be categorized as high risk if it is severe enough to meet their criteria (2012). Obviously, the prioritization of the mental health population is weak versus the medical patient population. The strategy of using non-traditional beds in the emergency room will only work if patient prioritization is implemented

Hospitals are experiencing patient congested emergency departments. At Baptist Memorial Hospital, the increase in patient volume and limited capacity contributes to long length of stays and patients leaving without being seen. As a result of overcrowded emergency rooms, patient length of stay becomes more important. Throughput times in the emergency department (ED) play a substantial role in patient and staff satisfaction. Length of stay in the ED is directly related to patient volume, patient acuity, lab turnaround times, and time to treatment, which is all connected to patient satisfaction. Long wait time

The Nationwide Emergency Department Sample (NEDS) is the largest all-payer emergency department (ED) database in the U.S., producing national assessments of hospital-based ED visits beginning in 2004. NEDS gathers information from 31 million ED visits at 950 hospitals. The age is coded 0 to 90 years, and any age greater than 90 is set to 90 [7]. The races include white, black, Hispanic, Asian/Pacific Islander, Native American, and other. The NEDS was designed to enable investigations of ED use patterns and to strengthen public health professionals, administrators, policy makers, and clinicians in their decision-making concerning this critical source of care. The ED serves a dual role in the U.S. health care system infrastructure, as a point

Introduced into Australian hospitals some time during the 1970’s, triage is defined in Merriam-Webster as “the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties” (Merriam-Webster Online, n.d.). Known today as the Australasian Triage Scale (ATS), five categories outlining descending levels of clinical urgency are used to facilitate prioritised yet equitable access to emergency health care services (Health Policies Priorities Principal Committee, 2011). This synopsis will briefly explore the Australian triage protocols, the service delivery performance of national hospital emergency departments, and how their performance affects the outcomes of patients presenting