Fewer Walk-in Patients Won't Help Overcrowded EDs

The study appeared in the April 2003 issue of Annals of Emergency Medicine.

The researchers measured overcrowding in the emergency department by examining how often the department diverted ambulances to other hospitals in 1999. They found that, on average, the ED diverted ambulances 41% of the time. They then sought to identify the factors contributing to overcrowding by studying the number of ambulance and walk-in patients, the number admitted to the hospital, the number waiting for beds, delays in assessing patients and their transfer to beds, and physician and nurse staffing. The results showed that the most important factors leading to overcrowding were related to those patients who were the most acutely ill and needed quick admission to the hospital.

This means that a hospital has to become more efficient in assessing and admitting the sickest patients to the appropriate wards. This may require more hospital beds and increased access to radiology tests and other resources in the off-hours, said the researchers. They found that the number of walk-in patients, most of whom have minor illnesses, had little impact on the overcrowding in the ED. A full waiting room does not compromise the ED's ability to deal with an acutely ill patient. Problems begin to occur when beds and stretchers in the ED are occupied by very ill patients who are waiting a long time for tests, decisions, or a hospital bed. At this point, the ED becomes overcrowded and slow to accept new patients.

"But the good news is that only about 10% of all emergency department patients need to be admitted, and that's the group we have to focus our efforts on,” said Dr. Martin Schull, assistant professor in emergency medicine at the University of Toronto (Canada).




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