Emergency department crowding in The Netherlands: managers' experiences

Area of Science:

• Emergency Medicine
• Healthcare Management
• Public Health

Background:

• Emergency department (ED) crowding is a growing concern globally, impacting patient care and operational efficiency.
• While anecdotal evidence suggests crowding in Dutch EDs, no comprehensive multicenter studies have quantified its extent or impact.
• This study addresses the knowledge gap regarding ED crowding in The Netherlands.

Purpose of the Study:

• To assess the current state of emergency departments in The Netherlands concerning patient length of stay (LOS).
• To evaluate emergency department nurse managers' perceptions and experiences of crowding.
• To identify factors contributing to ED crowding and measures implemented to mitigate it.

Main Methods:

• A nationwide survey was distributed to all 94 ED nurse managers in The Netherlands.
• The survey collected data on facility type, annual ED census, patient LOS, and the frequency and timing of crowding.
• Respondents also reported on measures taken to improve patient flow and manage crowding.

Main Results:

• A response rate of 67% (63 EDs) was achieved, with a mean of 24,936 annual ED visits per facility.
• Mean LOS was 119 minutes for discharged patients and 146 minutes for admitted patients.
• Consultation delays, laboratory and radiology delays, and hospital bed shortages were the primary drivers of crowding, with 68% of respondents experiencing it several times a week or daily, predominantly between 12:00 and 20:00.

Conclusions:

• Despite relatively short LOS, frequent ED crowding is a significant nationwide issue in The Netherlands, as reported by ED nurse managers.
• Delays in consultations, diagnostic services, and inpatient bed availability are major contributors to ED crowding.
• Hospitals are implementing measures like fast-tracking and hallway patient placement to manage crowding.