Abstract
ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.
Highlights
In a recent Israel Journal of Health Policy Research (IJHPR) article, Bashkin et al describe factors associated with prolonged length of stay (LOS) within a community emergency department (ED) in Israel [1]
The study by Baskin and colleagues To delve into this complex topic and understand the causes for prolonged LOS, Bashkin and her team spent time in the ED observing factors that led to longer ED LOS
Because many hospitals have not risen to the challenge to reduce ED crowding [8], several countries have instituted mandates for length of stay such as in England and Australia [21, 22]
Summary
The study by Baskin and colleagues To delve into this complex topic and understand the causes for prolonged LOS, Bashkin and her team spent time in the ED observing factors that led to longer ED LOS What they found were a variety of elaborate, inefficient processes in the ED and across the hospital, where several factors, many of them interdependent, led to prolonged LOS and higher levels of ED crowding. Factors were related both to demand for care and supply of resources.
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