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Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia.
Emerg Med J. 2005 May; 22(5):351-4.EM

Abstract

OBJECTIVE

Access block refers to the situation where patients in the emergency department (ED) requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame. We systematically evaluated the relationship between access block, ED overcrowding, ambulance diversion, and ED activity.

METHODS

This was a retrospective analysis of data from the Emergency Department Information System for the three major central metropolitan EDs in Perth, Western Australia, for the calendar years 2001-2. Bivariate analyses were performed in order to study the relationship between a range of emergency department workload variables, including access block (>8 hour total ED stay for admitted patients), ambulance diversion, ED overcrowding, and ED waiting times.

RESULTS

We studied 259,580 ED attendances. Total diversion hours increased 74% from 3.39 hours/day in 2001 to 5.90 hours/day in 2002. ED overcrowding (r = 0.96; 95% confidence interval (CI) 0.91 to 0.98), ambulance diversion (r = 0.75; 95% CI 0.49 to 0.88), and ED waiting times for care (r = 0.83; 95% CI 0.65 to 0.93) were strongly correlated with high levels of ED occupancy by access blocked patients. Total attendances, admissions, discharges, and low acuity patient attendances were not associated with ambulance diversion.

CONCLUSION

Reducing access block should be the highest priority in allocating resources to reduce ED overcrowding. This would result in reduced overcrowding, reduced ambulance diversion, and improved ED waiting times. Improving hospital inpatient flow, which would directly reduce access block, is most likely to achieve this.

Links

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Authors+Show Affiliations

Fatovich DM
University of Western Australia, Australia. daniel.fatovich@health.wa.gov.au <daniel.fatovich@health.wa.gov.au>
Nagree Y
No affiliation info available
Sprivulis P
No affiliation info available

MeSH

AmbulancesCrowdingEmergency Service, HospitalHealth Services AccessibilityHealth Services ResearchHumansPatient AdmissionRetrospective StudiesTime FactorsTriageWaiting ListsWestern Australia

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

15843704

Citation

Fatovich, D M., et al. "Access Block Causes Emergency Department Overcrowding and Ambulance Diversion in Perth, Western Australia." Emergency Medicine Journal : EMJ, vol. 22, no. 5, 2005, pp. 351-4.
Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J. 2005;22(5):351-4.
Fatovich, D. M., Nagree, Y., & Sprivulis, P. (2005). Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emergency Medicine Journal : EMJ, 22(5), 351-4.
Fatovich DM, Nagree Y, Sprivulis P. Access Block Causes Emergency Department Overcrowding and Ambulance Diversion in Perth, Western Australia. Emerg Med J. 2005;22(5):351-4. PubMed PMID: 15843704.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. AU - Fatovich,D M, AU - Nagree,Y, AU - Sprivulis,P, PY - 2005/4/22/pubmed PY - 2005/8/16/medline PY - 2005/4/22/entrez SP - 351 EP - 4 JF - Emergency medicine journal : EMJ JO - Emerg Med J VL - 22 IS - 5 N2 - OBJECTIVE: Access block refers to the situation where patients in the emergency department (ED) requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame. We systematically evaluated the relationship between access block, ED overcrowding, ambulance diversion, and ED activity. METHODS: This was a retrospective analysis of data from the Emergency Department Information System for the three major central metropolitan EDs in Perth, Western Australia, for the calendar years 2001-2. Bivariate analyses were performed in order to study the relationship between a range of emergency department workload variables, including access block (>8 hour total ED stay for admitted patients), ambulance diversion, ED overcrowding, and ED waiting times. RESULTS: We studied 259,580 ED attendances. Total diversion hours increased 74% from 3.39 hours/day in 2001 to 5.90 hours/day in 2002. ED overcrowding (r = 0.96; 95% confidence interval (CI) 0.91 to 0.98), ambulance diversion (r = 0.75; 95% CI 0.49 to 0.88), and ED waiting times for care (r = 0.83; 95% CI 0.65 to 0.93) were strongly correlated with high levels of ED occupancy by access blocked patients. Total attendances, admissions, discharges, and low acuity patient attendances were not associated with ambulance diversion. CONCLUSION: Reducing access block should be the highest priority in allocating resources to reduce ED overcrowding. This would result in reduced overcrowding, reduced ambulance diversion, and improved ED waiting times. Improving hospital inpatient flow, which would directly reduce access block, is most likely to achieve this. SN - 1472-0213 UR - https://www.unboundmedicine.com/medline/citation/15843704/Access_block_causes_emergency_department_overcrowding_and_ambulance_diversion_in_Perth_Western_Australia_ DB - PRIME DP - Unbound Medicine ER -