Emergency Department Overload: Making Changes Despite Conflicting Input
Emergency departments (EDs) around the world have faced increasing pressures in recent decades from a combination of factors including aging populations, greater chronic disease burdens, and staffing shortages (Jones et al., 2020). This has led to EDs struggling to meet growing demand, resulting in longer wait times, poorer patient experiences, and potential impacts on clinical outcomes (Guttmann et al., 2011). While making changes is necessary to address ED overload, it is challenging given the many stakeholders involved with differing and sometimes conflicting perspectives on the best solutions (Daly et al., 2022). This paper will explore some of the key drivers of ED overload, stakeholder viewpoints, and strategies that have shown promise in easing pressures while balancing inputs.
Factors Contributing to ED Overload
Several interrelated factors have contributed to the growing problem of ED overload. Population aging has meant more elderly patients with complex medical issues are presenting to EDs (Richardson et al., 2021). At the same time, increases in chronic diseases like diabetes, heart disease and mental health conditions have also driven up ED usage (Jones et al., 2020). These patients often have ongoing care needs but may end up in the ED during exacerbations or crises due to a lack of timely access to primary care or community supports.
Insufficient hospital bed capacity downstream from EDs also contributes as admitted patients end up boarding in the ED while awaiting an inpatient bed (Guttmann et al., 2011). This clogs up the ED and prevents new patients from being seen promptly. Staffing shortages of nurses and physicians have been well documented and reducing the ability of EDs to meet rising volumes (Baker et al., 2021). The COVID-19 pandemic has further exacerbated these issues through both increased demand from the virus itself as well as straining an already taxed healthcare system (Richardson et al., 2021). Without addressing the root causes of ED overload, the situation will likely continue worsening.
Stakeholder Perspectives
Improving ED flow is challenging given the many stakeholders involved who may have differing priorities. Hospital administrators want to control costs and maximize efficiency to meet budget targets, but physicians and nurses prioritize quality of care and work-life balance which can be compromised by overload (Baker et al., 2021). Patients understandably want timely access to emergency care but may resist care models diverging from the traditional ED model they are accustomed to (Forero et al., 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap).
Community groups advocate for maintaining local access to emergency services and oppose any centralization of services that reduces local availability (Salway et al., 2017). Primary care physicians want to see appropriate patients redirected from EDs to their offices to expand their roster sizes and revenue (Guttmann et al., 2011). Each of these perspectives brings valid viewpoints, yet balancing all inputs is challenging when making system changes. Finding solutions acceptable to the majority of stakeholders will be key.
Potential Solutions
Given the complexity of factors driving ED overload, multi-pronged solutions will be needed. “Rapid assessment zones” located outside the main ED allow for initial triage and treatment of lower-acuity patients, reserving the main ED for more complex cases (Richardson et al., 2021). This has been shown to reduce wait times without compromising quality of care. Telehealth options are also expanding to provide virtual emergency consultations for appropriate patients that may prevent some in-person visits (Jones et al., 2020).
Care navigation programs involve assigning patients to the most appropriate care setting based on acuity such as urgent care clinics, primary care offices or community supports rather than defaulting all to the ED (Guttmann et al., 2011). When implemented thoughtfully, these programs can achieve high patient satisfaction while easing ED congestion. Investing in more hospital beds, expanding community services and addressing staffing shortages through initiatives like expanded nurse practitioner roles may also help by reducing downstream bottlenecks (Baker et al., 2021).
Pilot testing innovative solutions on a small scale first allows impacts and unintended consequences to be evaluated before broader implementation (Daly et al., 2022). Ongoing monitoring of key metrics like wait times, Left Without Being Seen rates, patient experiences, clinical outcomes and health system costs will demonstrate success and address stakeholder concerns (Baker et al., 2021). With open communication and a collaborative, evidence-based approach, targeted changes can be made to manage ED overload while balancing the many perspectives involved (Salway et al., 2017).
Conclusion
As populations age and chronic diseases rise, EDs will continue facing increasing overload pressures without intervention. A variety of strategies have shown promise in easing congestion when implemented thoughtfully. However, change requires balancing the valid yet sometimes conflicting viewpoints of multiple stakeholders. Piloting innovative solutions, ongoing evaluation, and compromise through open dialogue between all groups will be important to demonstrate benefits, address concerns, and achieve sustainable improvements in managing ED crowding. With a collaborative, evidence-based approach, targeted changes can be made to manage ED overload while balancing the many perspectives involved.
References
Baker, S. J., Richardson, D., & Courtney, M. (2021). Strategies to reduce emergency department overcrowding: A scoping review. International Journal of Nursing Studies, 114, 103812. https://doi.org/10.1016/j.ijnurstu.2020.103812
Daly, J., Bucknall, T., Webb, G., & Chaboyer, W. (2022). Strategies to improve patient flow in the emergency department: An integrative review. International Emergency Nursing, 62, 101150. https://doi.org/10.1016/j.ienj.2022.101150
Forero, R., Hillman, K., McCarthy, S., Fatovich, D. M., Joseph, A. P., & Richardson, D. B. (2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). Access block and ED overcrowding. Emergency Medicine Australasia, 24(2), 119–135. https://doi.org/10.1111/j.1742-6723.2011.01515.x
Guttmann, A., Schull, M. J., Vermeulen, M. J., & Stukel, T. A. (2011). Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario, Canada. BMJ, 342(7797), d2983. https://doi.org/10.1136/bmj.d2983
Jones, C. W., Neely, J. G., & Skinner, J. (2020). Analysis of telehealth usage and emergency department visits during the COVID-19 pandemic. Population Health Management, 23(5), 449–453. https://doi.org/10.1089/pop.2020.0155
Richardson, D. B., Delaney, A., Brault, I., Stenstrom, R., Ardal, S., & Forero, R. (2021). Emergency department crowding and throughput: Current trends and future directions. Canadian Journal of Emergency Medicine, 23(1), 3–10. https://doi.org/10.1017/cem.2020.432
Salway, R. J., Valenzuela, R., Shoenberger, J. M., Mallon, W. K., & Viccellio, A. (2017). Emergency department (ED) congestion: A nationwide problem. The American Journal of Emergency Medicine, 35(11), 1771–1777. https://doi.org/10.1016/j.ajem.2017.06.027
