Total access block time: A comprehensive and intuitive way to measure the total effect of access block on the emergency department

Abstract

Access block refers to delayed transfer of admitted patients in the ED to wards from lack of an inpatient bed. Existing measures are crude indicators of its impact on ED function. Our aim was to devise measures of the total burden of access block on ED function which better measured the impact on ED function, yet were intuitive and easy to communicate. Current access block measures, reported as percentage of total inpatient admissions, are based upon time intervals and cut points. 'Total access block time' (TABT) is obtained by summing the minutes in excess of 8 h that admitted patients spend in the ED. We describe derivation of TABT with reference to its intuitive comprehensibility and potential to improve understanding and communication of access block issues. Two examples of months with similar traditional measures but different TABT are used to highlight its advantages. TABT varies over a greater range than traditional measures. High TABT months had higher presentations, higher admissions, more admitted patients with long ED stays and impaired ability to meet triage benchmarks. Differences in these parameters are considered intermediate end-points which reflect the degree of impairment of ED function. TABT is a comprehensive, sensitive indicator of total impact of access block on ED function. Unlike current access block measures, TABT is reflective of long-stay ED patients. Descriptive statistics derived from TABT, in terms of effective beds and bed-days lost, will likely improve the communication and comprehension of access block issues.