Reducing the number of walk-in patients won't help solve emergency department overcrowding: Study

On any given day, hospitals divert ambulances as much as 40 per cent of the time due to overcrowding in their emergency departments - but reducing the volume of walk-in patients with minor illnesses will not alleviate the problem, says a new study by University of Toronto researchers.

"There is much speculation about the causes of overcrowding and ambulance diversion, but little research has actually been done on this issue," says Dr. Michael Schull, assistant professor in emergency medicine at U of T and emergency department physician at Sunnybrook and Women's College Health Sciences Centre. "We felt it was important to examine the problem in a more systematic way, so we looked at the experience of Sunnybrook and Women's emergency department over a one-year period."

Schull and colleagues measured overcrowding in the emergency department by examining how often the department diverted ambulances to other hospitals in 1999. They found that, on average, the department diverted ambulances 41 per cent of the time. To identify the factors contributing to overcrowding, the researchers studied the number of ambulance and walk-in patients, the number admitted to and waiting for hospital beds, delays in the assessment of patients and their transfer to beds as well as physicians on duty and nursing staffing.

"We found the most important factors leading to overcrowding were related to those patients who were the most acutely ill and needed admission to a hospital bed," Schull says. "This suggests that if we're going to solve the problem of overcrowding then we have to increase a hospital's capacity to quickly assess, treat and admit patients who are the most acutely ill.

"We also found the number of walk-in patients, who tend to have minor illnesses, has very little impact on overcrowding in emergency. Efforts to encourage these patients to stay away from emergency departments and seek care in other places like doctor's offices probably won't do

Contact: Janet Wong
University of Toronto

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