Main features and control strategies to reduce overcrowding in emergency departments. A systematic review of the literature

Purpose: Overcrowding is a problem that affects emergency departments (ED) all over the world; it occurs due to a disproportion between user demand and the physical, human and structural resources available. Essential prerequisites to assessing and managing the phenomenon are its accurate measurement and an understanding of its impact. The objective of this systematic review is to identify the characteristics of the problem, analyzing the proposed strategies aimed at improving patient flow, delay in services provided and overcrowding of emergency departments. Methods: To achieve our objectives, a manual computerized search was performed in the bibliographic databases using as keywords “Emergency Department”, “Overcrowding”, “Emergency Room”, “Emergency Service”, “Emergency Unit”“,Emergency Ward”, “Emergency Outpatient Unit”, “Emergency Hospital”, “Crowding”, “Mass Gathering”, “Management” and “Comprehensive Health Care”. Two independent reviewers analyzed abstracts, titles and full text articles for admissibility, according to the selected inclusion and exclusion criteria. Results: The process lead to include 19 articles. It was possible to group the solutions proposed in five categories: work organization, investment in primary care, creation of new dedicated professional figures, work and structural modifications and implementation of predictive simulation models using mathematical algorithms. Conclusion: The most effective measures to guarantee an improvement in the flow of patients are represented by both improving the efficiency of human resources and by developing predictive mathematical models, regardless of the type of hospital and its location. Considering the complexity of EDs and the multiple characteristics of overcrowding and that the causes of crowding are different and site-specific, a careful examination of the specifics of each ED is necessary to identify improving fields

Application of the promethee II method in overcoming the bottleneck problem in an emergency department

Emergency department (ED) is a primary healthcare department and a key component of the whole healthcare system. The original mission of ED is to primarily handle only emergent situations. However, ED visits include a wide range of illnesses and injuries that is truly emergencies, urgent, semi-urgent, and non-urgent cases.As a result of this, EDs are overcrowded and the length of stay (LOS) of patients has increased, whereas quality of service has decreased. The decision maker (DM) should analyze and eliminate this problem in order to allocate and optimize the hospital resources more efficiently. This work discusses the application of PROMETHEE II method in solving the bottleneck problem in an ED. PROMETHEE II is a prominent method for multi criteria decision aid (MCDA) that builds a complete ranking on a set of potential actions. Microsoft Excel 2010 and Visual PROMETHEE software are used to implement the method. The emergency department in Hospital Universiti Sains Malaysia, Kubang Krian is taken as the case study in our work. The result shows that improve the time taken to deliver test result ranked first in improving the patient flow and the most sensitive criterion are to reduce the hospital infections

Improving waiting times in the Emergency Department

Waiting times in the Emergency Department cause considerable delays in care and in patient satisfaction. There are many moving parts to the ED visit with multiple providers delivering care for a single patient. Factors that have been shown to delay care in the ED have been broken down into input factors such as triaging, throughput factors during the visit, and output factors, which include discharge planning and available inpatient beds for admitted patients. Research has shown that throughput factors are an area of interest to decrease time spent in the ED that will lead to decrease waiting room times. In this Quality Improvement project, we will develop a systematic check in system with ED providers that will allow providers to identify any outstanding issues that may be delaying care or discharge. We hypothesize that this system will increase throughput in the ED by resolving any lab, radiology, or treatments that were overlooked. Reviewing the results of this QI project will allow us to see if we were effective in our timing of scheduled check-ins. Ultimately, this will reduce time spent in the waiting room by allowing more patients to be seen. In the era of the Affordable Care Act, more patients have access to affordable healthcare and will increase volume in the ED. This check-in system will allow more patients to be seen smoothly and in a timely manner that will improve and increase patient care and satisfaction in the ED

Emergency Department Utilization and Capacity

Synthesizes research on who utilizes emergency departments, how often for non-urgent or preventable conditions and why, how cost-sharing affects utilization, and how utilization patterns affect hospital finances, overcrowding, and cost implications