Hospital overcrowding is an issue that affects the efficiency and quality of healthcare provided to patients. Patients awaiting discharge from the emergency department (ED) are exposed to significant delays and are at risk of not receiving timely medical examinations and appropriate treatment, as well as suffering from a worse outcome compared to those who are promptly transferred out of the ED [1, 2]. Overcrowding also results in increased costs for hospitals because it increases operating expenses through boarding, waiting time, and resource utilization. Furthermore, it increases staff burnout, decreasing job satisfaction and resulting in suboptimal performance.
Overcrowding can be caused by many factors, including limited capacity and insufficient home care services. Another factor is the delay in transferring patients out of the ED, a situation known as exit block. Exit block has numerous negative effects, including increasing the length of stay in the ED and the hospital (LOS), patient discomfort, and lack of medical follow-up if the patient is not transferred to an appropriate department, such as a hospital outpatient clinic [3, 4].
Hospitals often experience persistent overcrowding because they are constantly full of admitted patients boarded in the ED. These patients require ICU and step-down beds, which are in short supply due to financial constraints, reduced hospital bed capacity, and the need for hospitals to operate at near capacity to remain profitable. While process improvements at the ED and diverting low acuity patients help reduce boarding, they do not solve the root cause of the problem. Instead, a comprehensive strategy that involves the entire hospital is needed to address this challenge.