Access block and ED overcrowding
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.
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ABSTRACT: Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data sources: A comprehensive search of four electronic databases from 2006-2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Review methods: A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning.International Journal of Nursing Studies 07/2014; 52(1). DOI:10.1016/j.ijnurstu.2014.07.006 · 2.25 Impact Factor
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ABSTRACT: As hospitals struggle to meet rising demand for their services, efficient capacity management is critical to the success of their efforts. A popular strategy employed by hospitals to meet the variability in demand for their services is to `flex' their capacity, i.e. to vary the number of available staffed beds to suit demand on a regular basis. This study uses data from a large tertiary hospital in South Australia to analyze the efficacy of their flexing protocols and the impact of flexing capacity on overcrowding. We also analyze the impact of variation in occupancy on patient flow parameters and compare this to previous studies conducted on similar sized Australian hospitals that do not flex capacity. Our findings reveal that flexing capacity helps the hospital spend less time over critical occupancy levels, and that the hospital does not show the signs of performance decline exhibited by hospitals that do not flex capacity. Areas for improvements in the flexing protocol and possible strategies are also identified. The findings support the use of flexing capacity as an efficient protocol and will serve as a useful guide for services seeking to improve existing capacity management protocols.
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ABSTRACT: Delayed hospital admissions from the ED are known in Australia as "access block". Access block and emergency department (ED) overcrowding are highly persistent world-wide problems. They can be described as the clay feet of an iron-clay sculpture. Methodologically, single-perspective approaches have done little to resolve these problems. We draw on a literature review, ethnographic data, and accounts of interventions using computational modelling to propose an integration of three-dimensional perspectives to address access block and ED overcrowding. The three dimensions are: epidemiological, socio-political, and dynamic systems dimensions. Virtual experimentation helps realise the potential to combine theory and data using top-down structural models of social and organisational change, bottom up models of individual behaviours and middle-out process models. As such, they have the potential to guide the development of the right mix of sustainable "iron made" and flexible short-term, "clay made" solutions. Through a multi-method approach, we will explore the processes attempting to create meaning in health, illness and disease as well as professional hierarchies and internal conflicts generated by lack of innovation at the policy level and the rapid developments in clinical practice. Evidence suggests that such an approach might assist the translation of research into policy and clinical practice.