A new governance of patient flows for hospital and community care. Impact on emergency department overcrowding and workload

Abstract

Emergency Department (ED) overcrowding is a global challenge, and although tailored local interventions are recommended, their effectiveness remains unclear. This retrospective study evaluated the impact of patient flow governance interventions on ED overcrowding at a large academic hospital. A three-phase (input-throughput-output) model was adopted to analyze factors affecting both static and dynamic indicators of ED overcrowding. Two 6-month periods (2019 vs 2023) were compared, accounting for organizational changes implemented between 2019 and 2022. Over 80% of ED visits involved lower-acuity conditions, and more than 40% of patients were aged over 65 years. ED stays longer than 24 h increased by 637%, whereas medical ward admissions decreased by 31.2% and the daily average number of off-unit admissions declined by 94.3%. The ED discharge rate rose by 3.3%, accompanied by a 200% increase in transfers of frail patients to community facilities. The overall self-discharge rate fell by 3.4%, even though the proportion of patients leaving before being seen increased by 15%. Organizational strategies focusing on throughput and output were associated with fewer hospital admissions and a substantial reduction in off-unit admissions, but these gains came at the cost of increased ED overcrowding and workload.

Keywords: emergency department overcrowding; emergency department workload; exit block; patient flow management.