Emergency department overcrowding and access block

Abstract

Emergency department overcrowding (EDOC) is defined as a situation where the demand for emergency services exceeds the ability of an emergency department (ED) to provide quality care within appropriate time frames. ED overcrowding has been a key issue in Emergency Medicine in Canada for more than 20 years. Despite increased political, administrative, and public awareness, EDOC situations continue to rise in frequency and severity. Patient suffering, prolonged wait times, deteriorating levels of service, adverse patient outcomes and the ability to retain experienced staff in an ED are all ill effects of this ongoing problem. Contrary to popular perceptions, ED overcrowding is not caused by inappropriate use of ED’s, or by high numbers of lower acuity patients presenting to the ED; the inability of admitted patients to access in-patient beds from the ED is the most significant factor causing EDOC in Canadian hospitals. Despite its importance, there currently are no national benchmarks in place to determine severity (and thus identify the factors causing poor performance). Through this position statement, CAEP will put forth recommended national benchmarks (targets) for ED performance to help address the issue. The suggested targets are as follows: