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Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia

D M Fatovich1, Y Nagree, P Sprivulis

  • 1University of Western Australia, Australia. daniel.fatovich@health.wa.gov.au <daniel.fatovich@health.wa.gov.au>

Emergency Medicine Journal : EMJ
|April 22, 2005
PubMed

Insights

Reducing emergency department (ED) access block is key to decreasing ED overcrowding and ambulance diversion. Improving hospital inpatient flow is the most effective strategy to reduce access block and improve ED waiting times.

Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Hospital Administration

Background:

  • Access block, defined as delayed inpatient bed access for ED patients, contributes to emergency department (ED) overcrowding.
  • ED overcrowding is a significant issue impacting patient care and hospital operations.
  • Ambulance diversion and prolonged ED waiting times are common consequences of access block.

Purpose of the Study:

  • To systematically evaluate the relationship between access block, ED overcrowding, ambulance diversion, and ED activity.
  • To identify the primary drivers of ED overcrowding and associated negative outcomes.
  • To inform resource allocation strategies for improving ED efficiency.

Main Methods:

  • Retrospective analysis of data from the Emergency Department Information System (EDIS) for three major metropolitan EDs in Perth, Western Australia (2001-2002).
  • Bivariate analyses were conducted to examine correlations between ED workload variables, including access block (>8-hour ED stay for admitted patients), ambulance diversion, ED overcrowding, and waiting times.
  • A total of 259,580 ED attendances were analyzed.

Main Results:

  • A 74% increase in total ambulance diversion hours was observed from 2001 to 2002.
  • High levels of ED occupancy by access-blocked patients strongly correlated with ED overcrowding (r=0.96), ambulance diversion (r=0.75), and ED waiting times (r=0.83).
  • Total attendances, admissions, discharges, and low-acuity patient attendances were not significantly associated with ambulance diversion.

Conclusions:

  • Reducing access block should be the highest priority for resource allocation to mitigate ED overcrowding.
  • Improvements in hospital inpatient flow are crucial for directly reducing access block.
  • Addressing access block is expected to decrease ED overcrowding, reduce ambulance diversion, and improve ED waiting times.
Abstract

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