Reducing emergency department crowding through a transition ward: a pre-post observational study

Emergency department (ED) crowding is a persistent global issue, particularly in tertiary and university hospitals, where delayed admissions impair patient flow. This study aimed to evaluate the impact of implementing a transition ward (TW), established in May 2022 as a temporary inpatient care area to accommodate eligible admitted ED patients awaiting hospital beds, on ED crowding, focusing on reductions in boarding patient numbers and overall patient volume in ED.

This prospective, observational, single-center study was conducted at the Adult ED of a tertiary hospital between April 23 and June 2, 2023. ED crowding data were collected six times per day, yielding a total of 216 data points. As a baseline reference, data from the identical period in 2021, before the implementation of the TW, were used for comparison. The primary outcomes were the number of boarding patients and the total number of ED patients. Secondary outcomes included the longest waiting time for admitted patients, and the longest waiting time for examination.

Following the implementation of TW, the median total number of ED patients decreased by 22.0% (from 41.0 to 32.0; median difference -9.0, 95% CI: -10.4 to -7.7), and the median number of boarding patients decreased by 25.0% (from 23.5 to 18.0; median difference -5.5, 95% CI: -6.7 to -4.3). The median longest examination waiting time decreased by 40.2% (from 66.0 minutes to 39.5 minutes; median difference -26.5, 95% CI: -36.9 to -16.1).

The TW was associated with significant reductions in total ED patient volume and boarding patient volume, particularly in a high-volume tertiary care setting. These findings suggest that TWs can contribute to measurable improvements in ED patient flow and reductions in access block. Based on these positive outcomes, similar units may be extended to other inpatient specialties.