The healthcare system has long struggled with hospital overcrowding. Overcrowding in hospitals is a problem of a mismatch between supply and demand. It results in patients waiting for consultation, diagnosis, treatment, transfer, or discharge. It has a wide range of adverse effects, including poor patient satisfaction, increased medical errors, and longer hospital stays.
Overcrowding is caused by a number of factors, including a lack of available hospital beds. When this occurs, patients are forced to wait in the ED until an inpatient bed becomes available. This leads to frustration for some patients and a tendency to leave without being seen, known as left without being seen (LWBS) rates. These are usually patients who need to be admitted to the hospital, and they can be at risk of adverse events and mortality.
Another cause of overcrowding is a self-inflicted problem in the form of hospitals’ own scheduling and triage practices. For example, surgeons may choose to schedule their surgeries based on their personal preferences rather than taking patient needs into account. This creates spikes in the demand for inpatient beds. It also causes problems for the ED, where nurses must triage patients based on surgical schedules, and can lead to delays in door-to-needle times.
Several studies have shown that patients who present to the ED when it is overcrowded have higher mortality rates than those who do not. This is because the staff in the ED must prioritize their efforts on new emergency cases, and the older patients who are already in the hospital experience longer hospital lengths of stay and have difficulty leaving the hospital to go home or to other community-based care settings. Increasing capacity in the ED and improving patient flow in the entire hospital are essential to solving this problem.