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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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Emergency overcrowding and access block: A smaller problem than we think.

Grant D Innes1, Marco L A Sivilotti2, Howard Ovens3

  • 1*Alberta Health Services,Departments of Emergency Medicine and Community Health Services,University of Calgary,Calgary, AB.

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Summary
This summary is machine-generated.

Emergency department access block, a major safety concern, is caused by prolonged inpatient boarding. Addressing this requires only minor hospital capacity or efficiency gains, around 1-3%.

Keywords:
accessemergencyovercrowdingpatient flow

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Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Hospital Operations

Background:

  • Emergency department (ED) access block is a critical safety issue in developed countries.
  • It stems primarily from prolonged inpatient boarding in EDs, delaying care for high-acuity patients.
  • Cumulative emergency access gap is a novel metric quantifying total emergency care delays.

Purpose of the Study:

  • To quantify cumulative emergency access blocks in Canadian hospitals.
  • To assess these blocks as a fraction of available inpatient capacity.

Main Methods:

  • A cross-sectional study using 2015 administrative data from 25 Canadian hospitals.
  • Calculated cumulative access gap for high-acuity patients (CTAS 1-3) by multiplying patient numbers by delay times.
  • Compared cumulative ED access gap to inpatient bed hours to determine fractional access gap.

Main Results:

  • The study included 1.79 million patient visits across 16 tertiary and 9 community EDs.
  • The mean cumulative ED access gap was 46,000 stretcher hours per site annually.
  • This gap represented a small fraction (1.14%) of total inpatient capacity.

Conclusions:

  • ED access gaps significantly impact high-acuity patient care.
  • However, these delays are relatively small compared to overall hospital capacity.
  • Improvements of 1-3% in hospital capacity or efficiency could substantially reduce ED access block.