Facing overcrowding in the emergency departments

Excerpt

ED crowding is a widespread issue that has been linked to increased morbidity and death [1]. In this edition of our journal, Pearce and colleagues from Alberta, Canada, provide a summary of systematic reviews on potential solutions to crowding and their efficacy [2]. The researchers retrieved 269 articles from the literature, and after quality assessment, they included 27 in the final review. Combined, these reviews encompass 368 mainly observational primary studies. The paper evaluates different interventions for ED patients' input, throughput, and output. However, determining which interventions produced specific benefits was often challenging because many studies assessed multiple interventions simultaneously. The authors conclude that although most literature on the impact of different solutions to ED crowding focuses on throughput interventions, the interventions targeting input and output had the most reliable results overall. Among specific interventions with strong and sustained results, Pearce and colleagues list patient streaming according to acuity, fast track models, expanding nursing capacity in the initiation of patient flow management, and full capacity protocols (i.e. patients being held upstairs, in hallways or dedicated areas under the responsibility of the unit that cannot yet accommodate the patient, when the ED is at full capacity). Patient education, political action, and increase in funding are also mentioned as important and effective interventions. Primary care physicians providing care for low acuity patients in EDs, Walk-in clinics, and GP cooperatives showed weak sustained results. …