Emergency department crowding: causes, consequences and solutions

Added April 22, 2020

Citation: Morley C, Unwin M, Peterson GM, et al. Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS One 2018; 13(8): e0203316
DOI: 10.1371/journal.pone.0203316

What is this? The COVID-19 pandemic is placing a strain on health systems and healthcare workers, and emergency department (ED) crowding may put people at higher risk of infection.

In this systematic review, the authors searched for studies that investigated the causes and consequences of, or solutions to, ED crowding. They did not restrict by type of study but limited their search to articles published in English between 2000 and 2018, and did their search in June 2018. They included 14 studies of the causes of crowding, 40 studies of the consequences of crowding and 52 studies of potential solutions to crowding in ED.

What was found: The majority of identified causes of crowding in ED related to the number and type of people attending ED and timely discharge from ED

Higher numbers of ED visits by elderly people with complex and chronic conditions increase crowding in ED.

Consequences of crowding include treatment delays for patients and potentially increased mortality.

Reported solutions to crowding in ED focused on efficient patient flow within the ED.

There were promising outcomes for solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets and extended hours of primary care.

What’s uncertain: The precise local factors which lead to crowding in ED and the actual impact of improving patient flow are uncertain.


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