EM Notes – Overcrowding & Access Block

Posted on May 25, 2016 by Hanno Davel
Factors
Pre hospital
Inc patient number / seasonal

Inc patient complexity

Inc patient expectation

Lack of available GP is not a major factor

ED
Triage

Medical – Dr/Nurse, No./Skill mix

Inv – XR, Path times

Allied health

ED design and size

Delays in decision-making

In-patient team – time to team review/necessary in ED intervention

Clerical/transport/bed allocation

Post ED/Access Block (pt for admission who remains in ED>8h because of delay in accessing inpatient bed)
Length of stay

Availability of outpatient/clinic

DC planning/lounge

Critical care/transfer

Admin

Resources – insufficient open beds, high hospital occupancy (> optimal 85%), availability of appropriate admission bed, specialisation of whole wards

Financial incentives – elective vs emergent

Impact of overcrowding (Consultoid issues)
Bio

Adverse events

Morbid/mortality – 20-30% extra, 1500+ more deaths/yr

Pt care

Infectious disease

Ψ/soc

Pt dissatisfaction/complaints

Staff stress

Financial strain on hosp/ED

Legal/ethical

Record mixing

Privacy

OH+S risk

Departmental

Increase wait time and hospital stay (+20-25%)

Communication load

Error risk

Solutions
Pre hospital
Pt – education, awareness

Appropriate non-ed services/clinics – GP, Clinics, Community groups

Ambulance service communication/coordination/distribution

Community health – prevention of illness

Direct interhospital/specialist rooms ward transfer/admission
In ED
Triage – Fast tracking

Team allocation to areas of ED

Supervisor vigilance of waiting times

Medical – Dr, Nurse, Allied, Inv

Skill mix and availability

Medications, Equipment, Education, Protocols, Staff

Design/layout/EMU

Systems – computerization, documentation, clinical pathways (PTCA, trauma calls), communication systems

Team – policies re admission

Time to review

Incentives

Clerical – bed officer, clerical, staff


Post ED


Surge beds
Shortened inpatient stay

Outpt mx

Clinics

Hospital in the home

DC planning (incl earlier DC ward rounds) / DC lounge

Info systems / bed tracking / bed availability

Incentives – Elective vs Emergent bed prioritisation (cancel elective surgery)
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