Overcrowding is a serious problem that has been linked to patient mortality, reduced quality of care, increased risk of hospital-acquired infections, decreased job satisfaction for medical and nursing staff, and poorer outcomes in general. It is a complex issue that requires multifaceted solutions at both macro- and microlevels.
Multiple studies show that ED overcrowding results in longer wait times for diagnostics, which leads to delay of treatment initiation and thus a vicious circle that feeds the overcrowding itself [12–14]. Moreover, as a result of long waits, patients who are not able to access triage are more likely to leave the ED without being assessed or treated, and a large number of these “walk-outs” will require subsequent admission[15].
Overcrowded conditions lead to poorer quality of care as it becomes difficult for the medical staff to focus on their tasks under stress. For example, Sills et al documented that overcrowding increases the duration of time to receive analgesia in children with asthma and long bone fractures [16]. Additionally, numerous studies have shown that ED overcrowding results an increase in medication errors, both errors of omission (i.e. not prescribing the right drug) and errors of commission (i.e. giving the wrong drug)[17].
Several macrolevel strategies to reduce overcrowding have been proposed, such as smoothing elective cases, enhancing weekend discharges, and implementing full capacity protocols (FCP). However, there is still room for improvement in terms of implementation and monitoring. Furthermore, the involvement of clinical experts throughout the pipeline is crucial to contextualise the data with medical and operational knowledge and provide the feedback necessary for decision-making reasoning.