Hospital overcrowding reduces the quality of care, puts patients at greater risk of adverse events, leads to staff burnout, and exacerbates costs. It can also lead to a loss of reputation and the exodus of patients who seek out other health care providers.
Overcrowding is typically caused by the inability to discharge or transfer admitted patients to wards due to lack of beds. As a result, those patients are forced to stay in the ED taking up space that could otherwise be used for more pressing patients. This problem can often be resolved by changing the procedures hospitals use to discharge patients from the ED into wards. These changes include having doctors write discharge orders earlier in the day and making housekeepers move patients more quickly once they are ready to be moved.
The goal of most performance-improvement programs that attempt to address ED overcrowding is to reduce the number of people who spend time in the emergency department, but these efforts often fail to produce sustained results. Moreover, they tend to focus on the ED, when many of the contributing factors are outside of the department’s control.
The most successful initiatives to improve ED overcrowding take a holistic approach that addresses both microlevel and macrolevel factors. The former includes strategies such as tele-triage and fast-track programs that provide prompt treatment for patients with less serious conditions, while the latter involves the establishment of observation units to help bridge the gap between ED and hospital care.