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

Area of Science:

• Healthcare Management
• Hospital Operations
• Emergency Medicine

Background:

• Emergency department (ED) crowding is a global challenge, particularly in tertiary hospitals, leading to delayed admissions and impaired patient flow.
• Implementing a transition ward (TW) offers a potential solution to alleviate ED crowding by managing admitted patients awaiting inpatient beds.

Purpose of the Study:

• To evaluate the impact of a transition ward (TW) on emergency department (ED) crowding.
• To assess reductions in boarding patient numbers and overall ED patient volume after TW implementation.

Main Methods:

• A prospective, observational, single-center study conducted in an Adult ED of a tertiary hospital.
• Collected ED crowding data six times daily over a defined period in 2023, comparing it to baseline data from 2021 before TW implementation.
• Primary outcomes included the number of boarding patients and total ED patients; secondary outcomes were longest waiting times for admission and examination.

Main Results:

• The median total number of ED patients decreased by 22.0% post-TW implementation.
• The median number of boarding patients in the ED decreased by 25.0%.
• The median longest examination waiting time saw a significant reduction of 40.2%.

Conclusions:

• The transition ward (TW) implementation was associated with significant reductions in ED patient volume and boarding patient volume.
• TWs demonstrate potential for measurable improvements in ED patient flow and reductions in access block in high-volume tertiary care settings.
• The success of TWs suggests their potential extension to other inpatient specialties to enhance hospital-wide patient flow.