Emergency department crowding

Emergency Medicine Journal

Volumn 29, Issue 6, 2012, Pages 437-443

  Higginson, Ian ^a  

^a DERRIFORD HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

COST; CROWDING; DESCRIPTIVE RESEARCH; EMERGENCY WARD; HUMAN; MORBIDITY; MORTALITY; PRIORITY JOURNAL; RETROSPECTIVE STUDY; REVIEW; STANDARD; UNITED KINGDOM;

CROWDING; EFFICIENCY, ORGANIZATIONAL; EMERGENCY SERVICE, HOSPITAL; GREAT BRITAIN; HUMANS; WAITING LISTS;

EID: 84861828588     PISSN: 14720205     EISSN: 14720213     Source Type: Journal    
DOI: 10.1136/emermed-2011-200532     Document Type: Review

References (118)

1. Department of Health. The NHS Plan. 2000. http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/PublicationsPolicyandGuidance/DH-4002960 (accessed 27 Dec 2009).
2. New Zealand Ministry of Health. "Shorter Stays in ED Health Target". http:// www.moh.govt.nz/moh.nsf/indexmh/ed-target (accessed 27 Dec 2009).
3. Prime Minister of Australia. New National Four Hour Target for Hospital Emergency Departments. 2010. http://www.pm.gov.au/node/6643 (accessed 5 May 2010).
4. Australian Government. Emergency Departments: Access Targets. http://www. yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/factsheet-hosp-05 (accessed 22 Sep 2010).
5. Department of Health. Revision to the Operating Framework for the NHS in England 2010/11. http://www.dh.gov.uk/prod-consum-dh/groups/ dh-digitalassets/@dh/@en/@ps/documents/digitalasset/dh-116860.pdf (accessed 22 Sep 2010).
6. Forero R, Hillman K. Access Block and Overcrowding: A Literature Review. http:// www.acem.org.au/media/media-releases/Access-Block-Literature-Review-08- Sept-3.pdf (accessed 27 Dec 2009).
7. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects and solutions. Ann Emerg Med 2008;56:126-36.
8. American College of Emergency Physicians. Practice Resources. Crowding. http://www.acep.org/practres.aspx?id=29156 (accessed 5 May 2010).
9. Canadian Association of Emergency Physicians. Position Statement. Emergency Department Overcrowding. http://www.caep.ca/template.asp? id=37C951DE051A45979A9BDD0C5715C9FE (accessed 5 May 2010).
10. Australasian College of Emergency Physicians. Statements. Emergency Department Overcrowding. http://www.acem.org.au/media/policies-and- guidelines/S57---Statement-on-ED-Overcr.pdf (accessed 5 May 2010).
11. Hwang U, Concato J. Care in the emergency department: how crowded is overcrowded? Acad Emerg Med 2004;11:1097-101. (Pubitemid 39244008)
12. Beniuk K, Boyle A, Clarkson P. Emergency department crowding: developing an operational definition using a delphi study. Poster Presentation at CEM Conference. 2010. Emerg Med J Published Online First: 23 December 2011. doi:10.1136/emermed-2011-200646
13. United States Government Accountability Office, Report to the Chairman, Committee on Finance, US Senate. Hospital Emergency Departments Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames. 2009. http://www.gao.gov/new.items/d09347.pdf (accessed 24 Feb 2010).
14. Canadian Agency for Drugs and Technology in Health. Frequency, Determinants, and Impact of Overcrowding in Emergency Departments in Canada: A National Survey of Emergency Department Directors. 2006. http://www.cadth.ca/ media/pdf/320c-Overcrowding-tr-e-no-appendices.pdf (accessed 24 Feb 2010).
15. Richardson D. 2009 Access Block Point Prevalence Survey. 2009. http://www. acem.org.au/media/Access-Block-Update-2009-2-201109-.pdf (accessed 5 May 2010).
16. Department of Health. Accident and Emergency. Total Time Spent in A&E. http:// www.dh.gov.uk/en/Publicationsandstatistics/Statistics/ Performancedataandstatistics/AccidentandEmergency/DH-079085 (accessed 22 Sep 2010).
17. Locker TE, Mason SM. Are these emergency department performance data real? Emerg Med J 2006;23:558-9. (Pubitemid 44295264)
18. NHS information centre. Accident and Emergency Provisional Quality Indicators. http://www.ic.nhs.uk/statistics-and-data-collections/hospital-care/ accident-and-emergency- hospital-episode-statistics-hes/provisional-accident- and-emergency-quality- indicators-for-england-experimental-statistics-by- provider-for-april-2011 (accessed 30 Sep 2010).
19. Flottemesch TJ, Gordon BD, Jones SS. Advanced statistics. Developing a model of emergency department census and defining operational efficiency. Acad Emerg Med 2007;14:799-809. (Pubitemid 47277430)
20. Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J 2003;20:406-9. (Pubitemid 37168211)
21. Spirulvis P, Grainger S, Nagree Y. Ambulance diversion is not associated with low acuity patients attending Perth metropolitan emergency departments. Emerg Med Australas 2005;17:11-15. (Pubitemid 40223119)
22. Schull MW, Kiss A, Szalia JP. The effect of low-complexity patients on emergency department waiting times. Ann Emerg Med 2007;49:257-64.
23. Asaro PV, Lewis LM, Boxerman SB. The impact of input and output factors on emergency department throughput. Acad Emerg Med 2007;14:235-42. (Pubitemid 46274417)
24. Harris A, Sharma A. Access block and overcrowding in emergency departments: an empirical analysis. Emerg Med J 2010;27:508-11.
25. Cooke MW, Wilson S, Halsall J, et al. Total time in English accident and emergency departments is related to bed occupancy. Emerg Med J 2004;21:575-6. (Pubitemid 39232188)
26. Dunn R. Reduced access block causes shorter emergency department waiting times: an historical control observational study. Emerg Med (Fremantle) 2003;15:232-8. (Pubitemid 36750030)
27. Schull MJ, Szalai JP, Schwartz B, et al. Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;11:1037-43. (Pubitemid 33032291)
28. Forster AJ, Stiell I, Wells G, et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003;10:127-33. (Pubitemid 36262571)
29. Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005;22:351-4. (Pubitemid 40667650)
30. Rathlev NK, Chessare J, Olshaker J, et al. Time Series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med 2007;49:265-71.
31. Thomas J, Cheng N. The Effect of a holiday service reduction period on a hospital's emergency department access block. Emerg Med Australas 2007;19:136-42. (Pubitemid 46608444)
32. Lucas R, Farley H, Twanmoh J, et al. Emergency department patient flow: the influence of hospital census variables on emergency department length of stay. Acad Emerg Med 2009;16:597-602.
33. Hillier DF, Parry GJ, Shannon MW, et al. The effect of hospital bed occupancy on throughput in the pediatric emergency department. Ann Emerg Med 2009;53:767-76.
34. Sprivulis PC, Da Silva JA, Jacobs IG, et al. The association between hospital overcrowding and mortality among patients admitted via Western Australia emergency departments. Med J Aust 2006;184:208-12.
35. Steele R, Kiss A. EMDOC (Emergency Department Overcrowding) Internet-based safety net research. J Emerg Med 2008;35:101-17.
36. Davis B, Sullivan S, Levine A, et al. Factors affecting ED length of stay in surgical critical care units. Am J Emerg Med 1995;13:495-500.
37. McConnell KJ, Richards C, Daya M, et al. Effect of increased ICU capacity on emergency department length of stay and ambulance diversion. Ann Emerg Med 2005;45:471-8. (Pubitemid 40591772)
38. Bazarian JJ, Schneider SM, Newman VJ, et al. Do admitted patients held in the emergency department impact the throughput of treat and release patients? Acad Emerg Med 1996;3:1113-18. (Pubitemid 26415787)
39. Richardson D. Association of access block with decreased ED performance. Acad Emerg Med 2001;8:575-6.
40. Liu S, Hobgood C, Brice JH. Impact of critical bed Status on emergency department patient flow and overcrowding. Acad Emerg Med 2003;10:382-5. (Pubitemid 36437798)
41. Timm NL, Ho ML, Luria JW. Pediatric emergency department overcrowding and impact on patient flow. Acad Emerg Med 2008;15:832-7.
42. McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high acuity patients. Ann Emerg Med 2009;54:492-503.e4.
43. Gilligan P, Winder S, Singh I, et al. The boarders in the emergency department study. Emerg Med J 2007;25:265-9.
44. Richardson DB. The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust 2002;177:492-5. (Pubitemid 35373436)
45. Liew D, Kennedy MP. Emergency department length of stay independency predicts excess inpatient length of stay. Med J Aust 2003;179:524-6. (Pubitemid 37461075)
46. Krochmal P, Riley TA. Increased health care costs associated with ED overcrowding. Am J Emerg Med 1994;12:265-6. (Pubitemid 24149392)
47. Eckstein M, Chan LS. The effect of emergency department overcrowding on paramedic ambulance availability. Ann Emerg Med 2004;43:100-5. (Pubitemid 38049534)
48. Bayley MD, Schwartz JS, Shofer FS, et al. The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. Ann Emerg Med 2005;45:110-17.
49. Falvo T, Grove L, Stachura R, et al. The opportunity loss of boarding admitted patients in the emergency department. Acad Emerg Med 2007;14:332-7. (Pubitemid 46469976)
50. Lucas R, Farley H, Twanmoh J, et al. Measuring the opportunity loss of time spent boarding admitted patients in the emergency department: a multihospital analysis. J Healthc Manag 2009;54:117-24.
51. Stuart P. A casemix model for estimating the impact of access block on the emergency department. Emerg Med Australas 2004;16:201-7. (Pubitemid 38901874)
52. Weiss SJ, Ernst AA, Derlet R, et al. Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. Am J Emerg Med 2005;23:288-94. (Pubitemid 40732260)
53. Poveloi SK, Quinn JV, Kramer NR. Factors associated with patients who leave without being seen. Acad Emerg Med 2005;12:232-6. (Pubitemid 40248883)
54. Veith TL, Rhodes KV. The effect of crowding on access and quality in an academic ED. Am J Emerg Med 2006;24:787-94. (Pubitemid 44693145)
55. Wellstood K, Wilson K, Eyles J. "Unless you went in with your head under your arm" Patient perceptions of emergency room visits. Soc Sci Med 2005;61:2363-73. (Pubitemid 41446241)
56. Pines JM, Garson C, Baxt WG, et al. ED crowding is associated with variable perceptions of care compromise. Acad Emerg Med 2007;14:1176-81. (Pubitemid 350123069)
57. Gilligan P, Gupta V, Singh I, et al. Why are we waiting? A study of the patients perspectives about their protracted stays in the emergency department. Ir Med J 2007;100:627-9.
58. Pines JM, Iyer S, Disbot M, et al. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med 2008;15:825-31.
59. Crook HD, Taylor DM, Pallant JF, et al. Workplace factors leading to planned reduction of clinical work among emergency physicians. Emerg Med Australas 2004;16:28-34. (Pubitemid 38552476)
60. Rondeau KV, Francescutti LH. Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction. J Healthc Manag 2005;50:327-40. (Pubitemid 41361943)
61. Hwang U, Richardson LD, Sonuyi TO, et al. The effect of emergency department crowding on the management of pain in older adults with Hip Fracture. J Am Geriatr Soc 2006;54:270-5.
62. Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med 2008;51:1-7.
63. Hwang U, Richardson L, Livote E, et al. Emergency department crowding and decreased quality of pain care. Acad Emerg Med 2008;15:1248-55.
64. Mills AM, Shofer FS, Chen EH, et al. The association between emergency department crowding and analgesia Administration in acute Abdominal pain patients. Acad Emerg Med 2009;16:603-8.
65. Chu K, Brown A. Association between access block and time to parenteral opioid analgesia in renal colic. A pilot study. Emerg Med Australas 2009;21:38-42.
66. Schull MJ, Morrison LJ, Vermeulen M, et al. Emergency department overcrowding and ambulance transport delays for patients with chest pain. CMAJ 2003;168:277-83. (Pubitemid 36205194)
67. Pham JC, Patel R, Millin MG, et al. The effects of ambulance diversion: a comprehensive review. Acad Emerg Med 2006;13:1220-7. (Pubitemid 44642347)
68. Pines J, Localio AR, Hollander J, et al. The impact of emergency department crowding measures on time to antibiotics for patients with community acquired pneumonia. Ann Emerg Med 2007;50:510-16. (Pubitemid 47600401)
69. Fee C, Weber EJ, Maak CA, et al. Effect of emergency department crowding on time to antibiotics in patients with community acquired pneumonia. Ann Emerg Med 2007;50:501-9.
70. Carr BG, Kaye AJ, Wiebe DJ, et al. Emergency department length of stay: a major risk factor for pneumonia in Intubated trauma patients. J Trauma 2007;63:9-12. (Pubitemid 47057554)
71. Schull MJ, Vermeulen M, Slaughter G, et al. Emergency department crowding and thrombolysis delays in acute Myocardial Infarction. Ann Emerg Med 2004;44:577-85. (Pubitemid 39573174)
72. Diercks DB, Roe MT, Chen AY. Prolonged emergency department stays of non-ST-Segment- elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med 2007;50:489-96. (Pubitemid 47603257)
73. Pines JM, Pollack CV Jr, Diercks Db, et al. An association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med 2009;16:617-25.
74. Richardson D, McMahon KL. Emergency department access block occupancy predicts delay to surgery in patients with fractured neck of femur. Emerg Med Australas 2009;21:304-8.
75. Hong YC, Chou MH, Liu EH, et al. The effect of prolonged ED stay on outcome in patients with necrotizing fasciitis. Am J Emerg Med 2009;27:385-90.
76. Richardson D. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 2006;184:213-16.
77. Shenoi RP, Ma L, Jones J, et al. Ambulance diversion as a proxy for emergency department crowding: the effect on pediatric mortality in a metropolitan area. Acad Emerg Med 2009;16:116-23.
78. Fatovich DM. Effect of ambulance diversion on patient mortality: how access block can save your life. Med J Aust 2005;183:672-3. (Pubitemid 43009450)
79. Bernstein SL, Aronsky D, Duseja R, et al. The effect of emergency department crowding on clinically orientated outcomes. Acad Emerg Med 2008;16:1-10.
80. Cooke M, Fisher J, Dale J. Reducing Attendances and Waits in Emergency Departments. 2004. http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1204-029 (accessed 18 Aug 2010).
81. Bond K, Ospina MB, Blitz S, et al. Interventions to Reduce Crowding in Emergency Departments. 2006. http://www.cadth.ca/index.php/en/hta/reports- publications/ search/publication/621 (accessed 18 Jul 2010).
82. Cameron P, Scown P, Campbell D. Managing access block. Aust Health Rev 2002;25:59-68.
83. Burns CM, Bennett CJ, Myers CT, et al. The use of cusum analysis in the early detection and management of hospital bed occupancy crises. Med J Aust 2005;183:291-4. (Pubitemid 41341673)
84. Yancer DA, Fishee D, Cole H, et al. Managing capacity to reduce emergency department overcrowding and ambulance diversions. Jt Comm J Qual Patient Saf 2006;32:239-45.
85. Munro J, Mason S, Nicholl J. Effectiveness of measures to reduce emergency department waiting times: a natural experiment. Emerg Med J 2006;23:35-9. (Pubitemid 43056360)
86. Cameron PA, Kennedy MP, McNeil JJ. The effects of bonus payments on emergency service performance in Victoria. Med J Aust 1999;171:243-6. (Pubitemid 29429812)
87. Derlet RW, Nishio D, Cole L, et al. Triage of patients out of the emergency department; three year experience. Am J Emerg Med 1992;10:195-9.
88. Washington DL, Stevens CD, Shekelle PG, et al. Next day care for emergency department users with non acute conditions. Ann Intern Med 2002;137:707-14.
89. Diesburg-Stanwood A, Scott J, Oman K, et al. Nonemergency ED patients referred to community resources after medical screening examination: characteristics, medical condition after 72 hours, and use of follow-up services. J Emerg Nurs 2004;30:312-17. (Pubitemid 39060671)
90. Nash K, Nguyen H, Tillman M. Using medical screening examinations to reduce emergency department overcrowding. J Emerg Nurs 2009;35:109-13.
91. Lagoe RJ, Jastremski MS. Relieving overcrowded emergency departments through ambulance diversion. Hosp Top 1990;68:23-7.
92. Proudlove NC, Gordon K, Boaden R. Can good bed management solve the overcrowding in accident and emergency departments. Emerg Med J 2003;20:149-55. (Pubitemid 36388882)
93. Sinreich D, Marmor Y. Ways to reduce patient turnaround time and improve service quality in emergency departments. J Health Organ Manag 2005;19:88-105. (Pubitemid 40839586)
94. Gorelick MH, Yen K, Yun H. The effect of in room registration on emergency department length of stay. Ann Emerg Med 2005;45:128-33.
95. Takakuwa KM, Shofer FS, Abbuhl SB. Strategies for dealing with emergency department overcrowding: a one-year study on how bedside registration affects patient throughput times. J Emerg Med 2006;32:337-42. (Pubitemid 46710316)
96. Holroyd BR, Bullard MJ, Latoszek K, et al. Impact of a triage liaison physician on emergency department throughput: a randomized controlled trial. Acad Emerg Med 2007;14:702-8. (Pubitemid 47071771)
97. Lewandrowski K. How the clinical laboratory and the emergency department can work together to move patients through quickly. Clin Leadersh Manag Rev 2004;18:155-9.
98. Singer AJ, Viccellio P, Thorde HC Jr, et al. Introduction of a stat laboratory reduces emergency department length of stay. Acad Emerg Med 2008;15:324-8.
99. Storrow AB, Zhou C, Gaddis G, et al. Decreasing Lab turnaround time improves emergency department throughput and decreases emergency medical services diversion: a simulation model. Acad Emerg Med 2008;15:1130-5.
100. King DL, Ben-Tovim DI, Bassham J. Redesigning emergency department patient flows: application of Lean Thinking to health care. Emerg Med Australas 2006;18:391-7. (Pubitemid 43979283)
101. Miro O, Sanchez M, Espinosa G, et al. Analysis of patient flow in the emergency department and the effect of an extensive reorganization. Emerg Med J 2003;20:143-8. (Pubitemid 36388880)
102. Thornton V, Hazell W. Junior Doctor Strike Model of Care: reduced access block and predominant Fellow of the Australasian College for Emergency Medicine staffing improves emergency department performance. Emerg Med Australas 2008;20:425-30.
103. Boyle AA, Robinson SM, Whitwell D, et al. Integrated hospital emergency care improves efficiency. Emerg Med J 2008;25:78-82. (Pubitemid 351193830)
104. Bazzoli GJ, Brewster LR, Liu G, et al. Does U.S. hospital capacity need to be expanded? Health Aff 2003;22:40-54. (Pubitemid 41399220)
105. Khare R, Powell E, Reinhardt G, et al. Adding more beds to the emergency department or reducing admitted patient boarding times: which has a more significant influence on emergency department congestion? Ann Emerg Med 2009;53:575-85.
106. Han JH, Zhou C, France DJ, et al. The effect of emergency department expansion on emergency department overcrowding. Acad Emerg Med 2007;14:338-43. (Pubitemid 46464033)
107. Viccellio A, Santora C, Singer AJ, et al. The association between transfer of emergency department boarders to inpatient hallways and mortality. A 4 year experience. Ann Emerg Med 2009;54:487-91.
108. Hung GR, Kissoon N. Impact of an observation unit and an emergency department-admitted patient transfer mandate in decreasing overcrowding in a pediatric emergency department. A discrete event simulation exercise. Pediatr Emerg Care 2009;25:160-3.
109. Quinn JV, Mahadevan SV, Eggers G, et al. Effects of implementing a rapid admission policy in the ED. Am J Emerg Med 2007;25:559-63. (Pubitemid 46824170)
110. Gilligan P, O'Kelly P, Hegarty D, et al. The Transit/admission Lounge study. Ir Med J 2009;102:19-21.
111. Gomez-Vaquero C, Soler AS, Pastor AJ, et al. Efficacy of a holding unit to reduce access block and attendance pressure in the emergency department. Emerg Med J 2009;26:571-2.
112. Moloney ED, Bennett K, O'Riordan D, et al. Emergency department census of patients awaiting admission following reorganization of an admissions process. Emerg Med J 2006;23:363-7. (Pubitemid 44295291)
113. Kelen G, Scheulen JJ, Hill P. Effect of an emergency department (ED) managed care unit on ED overcrowding and emergency medical services diversion. Acad Emerg Med 2001;8:1095-100. (Pubitemid 33032301)
114. Frank R, Fawcett L, Emmerson B. Development of Australia's first psychiatric emergency centre. Australas psychiatry 2005;13:266-72. (Pubitemid 41800923)
115. Department of Health. Hospital Activity Statistics. http://www. performance.doh. gov.uk/hospitalactivity/ (accessed 21 Aug 2010).
116. Slack N, Chambers S, Johnston R.Operations Management. 4th edn. Harlow, UK: Pearson Education Ltd, 2004;399.
117. Morris Z, Boyle A, Beniuk K, et al. Emergency department crowding: Towards an agenda for evidence-based intervention. Emerg Med J. Published Online First: 7 June 2011. doi:10.1136/emj.2010.107078.
118. Department of Health. A&E Clinical Quality Indicators: Implementation Guidance and Data Definitions. http://www.dh.gov.uk/en/ Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH-122868 (accessed 30 Sep 2010).