Emergency Department Crowding

Emergency Department Crowding and Patient Flow

Emergency department (ED) crowding and inefficient patient flow is one of the primary issues affecting hospital around the word. The problem of overcrowding responds to many aspects, including internal and external factors, but one thing is clear, improving patient flow and minimize ED crowding is a top priority for healthcare organizations these days (Di Somma et al., 2015). Improving patient flow through the emergency department and hospital setting requires the need to identify the problem and propose the best strategy that should be deployed.

Setting

The phenomenon of ED crowding and patient flow occur in a setting where the demand for medical services exceed capacity and resources available.

Crowding has been related to increase morbidity, mortality, treatment delays and patient dissatisfaction (Gaieski et al., 2017). Hospital finance suffers when ambulances have to be diverted to a different hospital because of ED crowding; when patients experimenting delays in ED, decide to leave without receiving care; and when the lent of state (LOS) rise because of ineffective patient flow, which could lead to hospital acquired infections, pressure ulcers, readmissions and decrease hospital reimbursement (Alireza, Samad Shams, & Roshan, 2017). In the other hand, ED crowding and deficiency in patient flow likewise, have a direct impact on staff, including nursing dissatisfaction, burnout, absenteeism and work-related stress and injuries, resulting in experienced staff leaving and increase turnover. All these generates a non-safe hospital environment where medical errors are more likely expected to happen and quality of care is very poor (Foley, Kifaieh & Mallon,

Approaches to solve the problem should be directed to decrease ED demand (input), optimize throughput (ED triage, management and treatment), facilitate output (discharge home or admission to a hospital unit) and improve health care system (financial, health insurance, academic programs, health care policy and medical technology).

Strategies to decrease ED input should emphasize in promote patient education in our communities, better management of chronic conditions and preventive care, as well as increase number of primary care physicians (PCP), walking clinics or urgent care. Strategies to enhance ED throughput should be focused in improve triage process, use of tele tracking system, and creation of rapid assessment zones (Sayah et al., 2014). It is also important to maximized resources and staff according to patient demand, team work collaboration, facilitate access to diagnostic testing, expediate results and consultation process. Approaches to optimize ED output include improve use of inpatient beds, creation of observation and medical assessment units, which will allow moving patient faster out of ED, while waiting for further testing, results or treatment and get optimized for discharge. The same way, creation of inpatient discharge units, could facilitate making inpatients beds available for new patients, while discharge arrangements are