Article

Access block and ED overcrowding.

Simpson Centre for Health Services Research Affiliated with The Australian Institute of Health Innovation, University of New South Wales, Kensington, New South Wales, Australia.
Emergency medicine Australasia: EMA (Impact Factor: 0.99). 04/2010; 22(2):119-35. DOI: 10.1111/j.1742-6723.2010.01270.x
Source: PubMed

ABSTRACT Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. The rate of available beds in Australia reduced from 2.6 beds per 1000 (1998-1999) to 2.4 beds per 1000 (2002-2007) in 2002, and has remained steady at between 2.5-2.6 beds per 1000. In the same period, the number of ED visits increased over 77% from 3.8 million to 6.74 million. Similarly, the number of public hospital admissions increased at an average rate of 3.4% per year from 3.7 to 4.7 million. Compared with 1998-1999 rates, the number of available beds in 2006-2007 is thus similar (2.65 vs 2.6 beds per 1000), but the number of ED presentations has almost doubled. All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.

0 Bookmarks
 · 
170 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To describe and compare characteristics and process outcomes of patient presentations made to a public hospital Emergency Department (ED) for mental health (MH) and nonmental health (NMH) diagnoses. Methods This was a descriptive, retrospective cross-sectional study of patients who presented to an Australian hospital ED between September 2011 and September 2012. Demographic, clinical and outcomes data were extracted from the ED information system. MH presentations were compared to NMH presentations. Results Nearly 5% of the 66,678 ED presentations were classified as MH. Compared to the NMH group, a lower proportion in the MH group were seen by a physician within the recommended time frame (39.1% vs. 42.1%, p<0.001); had a higher admission rate (36.6% vs 20.1%, p<0.001); shorter ED length of stay (LoS) if admitted (369 vs, 490 mins, p<0.001) and longer ED LoS if not admitted (241 vs.187 mins, p<0.001). Conclusion Time constraints in the busy ED environment are a potential barrier to the delivery of care for all patients who have the right to timely access to health care. Targeted improvements at the front end of the ED system and output processes between ED, community and inpatient admission are recommended for this site.
    International emergency nursing 01/2013;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED; disrupting timely access to urgent care, posing a threat to patient safety. The aim of this review is to summarise the findings of studies that have investigated the extent of and the reasons for increasing emergency presentations. To do this, a systematic review and synthesis of published and unpublished reports describing trends and underlying drivers associated with the increase in ED presentations in developed countries was conducted. Most published studies provided evidence of increasing ED attendances within developed countries. A series of inter-related factors have been proposed to explain the increase in emergency demand. These include changes in demography and in the organisation and delivery of healthcare services, as well as improved health awareness and community expectations arising from health promotion campaigns. The factors associated with increasing ED presentations are complex and inter-related and include rising community expectations regarding access to emergency care in acute hospitals. A systematic investigation of the demographic, socioeconomic and health-related factors highlighted by this review is recommended. This would facilitate untangling the dynamics of the increase in emergency demand.
    Emergency Medicine Journal 10/2010; 28(5):373-7. · 1.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The term „Emergency Health Services‟ (EHS) encompasses hospital Emergency Departments (ED), ambulance services and a range of aero-medical, retrieval, and transfer services that provide integrated medical care to people suffering acute illness and injury. EHS is a significant and high profile component of Australia‟s health care system and congestion of these, evidenced by physical overcrowding and prolonged waiting times, is causing considerable community and professional concern. This concern relates not only to Australia‟s capacity to manage daily health emergencies but also the ability to respond to major incidents and disasters. EHS congestion is a result of the combined effects of increased demand for emergency care, increased complexity of acute health care, and blocked access to ongoing care (e.g. inpatient beds). Despite this conceptual understanding there is a lack of robust evidence to explain the factors driving increased demand, or how demand contributes to congestion, and therefore public policy responses have relied upon limited or unsound information.
    01/2011; Queensland University of Technology., ISBN: 978-1-921897-11-5