Addressing overcrowding in an emergency department: an approach for identifying and treating influential factors and a r
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(2020) 9:37
ORIGINAL RESEARCH ARTICLE
Open Access
Addressing overcrowding in an emergency department: an approach for identifying and treating influential factors and a reallife application Guy Wachtel*
and Amir Elalouf
Abstract Background: Overcrowding in hospital emergency departments that arises from long length-of-stay is an unfortunate common occurrence. While some factors affecting length-of-stay are well known, there may be additional factors that have not yet been properly addressed. This research offers a method for emergency department managers to use available data from their departments to identify new factors that significantly influence emergency departments crowding and patient length-of-stay. Methods: We propose an algorithm that can assist emergency department managers in determining which of these factors to address, given budgetary constraints. We implemented it in a case study which takes into account factors that are known to be influential, e.g., reason for arrival, occupancy in the emergency department, and arrival time, as well as factors that are explored for the first time in this paper, such as patient heart rate, the number of accompanying escorts, and the number of tests assigned to patients (e.g., blood tests and urinalysis). Results: All the implemented and new factors are shown to have a significant influence on the length-of-stay and crowding. We also obtained additional support for our results by interviewing emergency departments physicians and nurses from various hospitals. Conclusions: It is expected that, by taking all the above factors into consideration, emergency departments efficiency can be improved. The algorithm constructed here allows the choice of the most cost-effective factors to be improved, subject to a given budget. We have been able to derive practical recommendations that emergency departments managers might use to limit crowding and patient length-of-stay. Keywords: Emergency departments, Overcrowding, Length of stay, New factors, Algorithm
Introduction A hospital’s emergency department (ED) is responsible for evaluating patients when they first arrive and subsequently assigning them to appropriate departments in the hospital or referring them to general practitioners or to specialists for further treatment. Long length-of-stay (LOS) and overcrowding in EDs are serious yet commonplace problems in
health-care systems around the world, and in Israel in particular. In fact, major media outlets publish articles almost weekly on overcrowding in EDs, reporting ED patient occupancy of more than 200% [29]. To handle overcrowding, many hospitals determine a maximum number of patients who can occupy the ED and, once this level is exceeded, refer incoming patients and ambulances to other EDs in the area, and even outright reject non-urgent cases. Clearly,
* Correspondence: [email protected] Department of Management, Bar-Ilan University, 5290002 Ramat Gan, Israel © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0
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