Causes Of Overcrowding Research Articles

Behavioural modelling of metro car choice

Overcrowding in metro systems can exert a negative impact on the travel experience of the passengers and on the system’s capacity. This can affect passengers in different ways, worsening their perception of safety, altering their behaviour, decreasing their satisfaction, and leading to higher travel-time sensitivities. One of the causes of overcrowding can be attributed to some metro cars being selected more often than others, and thus, the distribution of passengers inside the train not being homogeneous. This study adopts a disaggregated approach based on the observed behaviour to understand why some specific metro cars are preferred. The characteristics of passengers and metro cars that generate heterogeneity in the load profiles are identified and the motives behind passenger choices are understood by formulating a hybrid latent-class choice model. The behavioural models consider sociodemographic characteristics, level-of-service information, and attitudinal latent variables. Once a metro car choice model was obtained, an operational micro-simulator of the metro was programmed to evaluate how passengers' choices would be affected by altering variables related to the design of the stations, assessing it based on the current situation. Subsequently, interventions to station layouts are made based on the forecast of the behavioural models, to affect passenger choices and produce more homogeneous passenger distributions in the train. The intervention presented in this study reduced 46.49 h of total travel time during the morning peak hours; the impact was greater when considering individual perceptions. Incentives can be developed for optimising the distribution of passengers in metro cars by understanding passenger choice using a behavioural approach, and therefore, they can improve the passenger experience.

Balancing Urban Development: Literature on the Nexus Between Affordable Housing and Urban Sprawl

The complex relationship between affordable housing and urban sprawl has major implications for cities all over the world. While urban sprawl offers lower housing costs and increased space as benefits, it also does present serious environmental, social, and economic issues. Undoubtedly, the rising cost of housing in the urban centers has forced the no income and the low-income populations to the periphery and thus increasing economic inequality and displacement. The growing urban sprawl has given rise to environmental degradation, social isolation, and economic inefficiency, which is further intensifying the displacement of low-income individuals and their families. This again is the remote cause of overcrowding as it restrains upward economic mobility. The aim of this research is to examine the complex relationship that exists between affordable housing and urban sprawl, and to propose ways to balance these dynamics. Key objectives include analyzing the adverse impacts of urban sprawl on the environment, societal fabric, and economic productivity; investigating the driving forces behind rising housing costs and their repercussions on low-income households; evaluating existing policies and strategies addressing affordable housing and urban sprawl; and proposing innovative solutions for sustainable urban development with equitable access to affordable housing. With the use of a literature review methodology, this study offers a comprehensive strategy. Stronger land use planning and zoning, improved public transportation and active transportation infrastructure, the expansion, building and preservation of more affordable housing, the promotion of social justice and community involvement and the use of technology and data-driven approaches are policy recommendations. The adoption of micro-units and tiny homes, co-housing and shared living arrangements, adaptive reuse and mixed-use development, community land trusts and housing cooperatives are some of the innovative recommendations. By striking a balance between affordable housing and sustainable urban development, these strategies hope to foster inclusive and thriving cities. Keywords: Urban sprawl, Affordable housing, Sustainable urban development, Low-Income Households, Land-Use Policy, Compact city planning, Community engagement

A Retrospective Cohort Study of Elderly Patients with Frequent Visits to A Tertiary Academic Hospital

Objectives: Frequent visits are one of the main causes of overcrowding in emergency departments of hospitals. Identifying the characteristics of frequent patients will help the managers of the medical service delivery system to provide more effective strategies to reduce the number of visits to the emergency department. This study was designed with the aim of determining the rate and causes of repeated visits of elderly people to the emergency room of a tertiary academic hospital in 2022. Method: This was a descriptive-cross-sectional study. The statistical population of this research included all elderly people who visited the emergency room more than once. Data were recorded in researcher-made checklists. Finally, the data were analyzed with SPSS version 25 software. Results: Of 200 cases included 118 (59%) cases were men and 82 (41%) cases were women. The average age was 85.70 ± 10.76, 190 of cases (95%) had a chronic disease and 10 cases (5%) did not. 144 cases (72%) were married and 56 cases (28%) were single. In terms of education level, most (74%) patients were illiterate. In terms of employment status, 24% were unemployed .72 cases (43%) of the patients lived with their spouses. Abdominal pain was the most frequent reason for visiting the hospital among elderly people. Also, in terms of medical diagnosis, the highest rate (35%) of diagnoses belonged gastrointestinal conditions. Conclusions: The results showed that the most common reason for frequent visiting was abdominal pain. Also, in terms of medical diagnosis, the most diagnosis was gastrointestinal conditions.

Implementasi Peraturan Gubernur Dki Jakarta Nomor 10 Tahun 2015 Tentang Penataan Dan Pemberdayaan Pedagang Kaki Lima Oleh Satuan Polisi Pamong Praja Di Pasar Minggu Jakarta Selatan

Pasar Minggu is one of the oldest markets in DKI Jakarta which is one of the causes of overcrowding, resulting in limited selling space. The lack of selling land has pushed some people to turn into street vendors (PKL) since the expansion of the Jakarta City area. As a result, Pasar Minggu has become an unorganized area, in this case it is contrary to DKI Jakarta Regulation Number 10 of 2015 concerning Arrangement and Empowerment of Street Vendors. This research is aqualitative research that aims to find out how the implementation, supporting and inhibiting factors and the right strategy in the arrangement and control of street vendors carried out by the Civil Service Police Unit at Sunday Market, South Jakarta. This study explains that there are 4 (four) indicators of policy implementation, namely communication, resources, disposition and bureaucratic structure. The process of collecting data using observation techniques, interviews, and documentation. The results showed that the implementation of DKI Governor Regulation Number 10 of 2015 concerning Arrangement and Empowerment of Street Vendors by the Civil Service Police Unit at Pasar Minggu, South Jakarta has not run optimally due to several factors, such as the lack of awareness of street vendors about order, not yet optimal enforcement of regulations, and lack of socialization of regulations. The strategies that can be used to improve the implementation of these regulations are improving the quality of Satpol PP human resources through education and training, conducting outreach related to structuring street vendors and optimizing Satpol PP tasks so they can work optimally.

Electronic file data analysis to improve health services and impact health policies. A pilot study

Abstract Background An important issue faced by Emergency Departments (ED) worldwide is “overcrowding”, whereby demand for health services exceeds available resources and may lead to increased morbidity and mortality. One cause of overcrowding is patients’ visits characterized as “avoidable” or “inappropriate”. Our study aims to estimate their prevalence in a Cardiology ED of a tertiary hospital. Methods This is a cross-sectional study, utilizing electronic files of patients attending a Cardiology ED during 2021. Using predefined criteria including tests, treatments, referral to/by other specialties/healthcare facilities and final admission, visits are categorized as either “inappropriate” or not. Our pilot results include all patients attending Cardiology ED on two separate days, one weekday and one weekend, in two different seasons, to account for respective variations. Results 55 patients (28 females) were studied with a mean age of 53.3 years, of whom 16 (29.1%) were transported by ambulance and 9 (16.4%) were finally admitted. Main analysis showed that 4/55 (7.3%) visits were “inappropriate”, however, in 13/51 (25.5%) of the “appropriate” visits, the sole criterion was D-dimers testing. A prespecified sensitivity analysis including them in the “inappropriate” group, increased the prevalence of “inappropriate” visits to 30.9% (17/55). Conclusions Our results show that a considerable proportion of visits in a Cardiology ED may be “inappropriate”, and thus could be more suitable for primary care management. If confirmed by our full study results, this could trigger a health policy reform, aiming to increase the role of primary care thus reducing ED “overcrowding”. Key messages • To our knowledge, this is the first study evaluating “inappropriate” Emergency Department visits, focused solely on a Cardiology ED. • The considerable proportion of patients who could be managed in primary care, paves the way for novel healthcare policies to reform ED services in Greece.

OVERCROWDED CLASSROOMS AT YEMENI BASIC SCHOOLS: TEACHERS’ PERSPECTIVES

The purpose of this study is to recognize the causes of overcrowding in primary schools in the north of Yemen, from the viewpoint of Yemeni teachers. The researcher took a qualitative approach. An online semi-structured interview was used for collecting the data. This research was conducted on teachers from Yemen's various primary schools. They were questioned about overcrowding in classrooms and the factors that contribute to it. Findings revealed that lacking infrastructure such as classrooms is one of the causes of such overcrowding. Other causes are to have only one school in some areas, and not having enough teaching staff.

Emergency department overcrowding: Causes, impacts, and strategies for effective management

Background: Emergency department (ED) overcrowding arises from an imbalance between patient demand and hospital capacity, significantly affecting hospital systems and patient care. Overcrowding, characterized by a mismatch between healthcare demand and available resources, leads to delays in diagnostic processes and treatment initiation, negatively impacting patient outcomes and hospital efficiency. Aim: This narrative review aims to analyze the causes, impacts, and strategies for managing ED overcrowding. It seeks to provide a comprehensive understanding of the contributing factors and propose solutions to mitigate the issue effectively. Methods: The review employs a narrative analysis approach, examining the input–throughput–output model to understand the dynamics of ED overcrowding. It categorizes factors into input, throughput, and output, exploring their interconnections and influence on overcrowding. The review also assesses signs of overcrowding, including delays in treatment and the impact of exit block and boarding. Results: The analysis identifies key causes of overcrowding, such as limited hospital bed availability, exit block, and boarding. It highlights how these factors lead to extended waiting times, increased mortality rates, and reduced patient satisfaction. The review also examines the impact of the COVID-19 pandemic on overcrowding, emphasizing the role of output and throughput factors.

La saturation de la structure des urgences et le rôle de l'organisation hospitalière : réflexions sur les causes et les solutions

Emergency Department (ED) overcrowding is a silent killer. Thus, several studies in different countries have described an increase in mortality, a decrease in the quality of care and prolonged hospital stays associated with ED overcrowding. Causes are multiple: input and in particular lack of access to lab test and imaging for general practitioners, throughput and unnecessary or time-consuming tasks, and output, in particular the availability of hospital beds for unscheduled patients. The main cause of overcrowding is waiting time for available beds in hospital wards, also known as boarding. Solutions to resolve the boarding problem are mostly organisational and require the cooperation of all department and administrative levels through efficient bed management. Elderly and polypathological patients wait longer time in ED. Internal Medicine, is the ideal specialty for these complex patients who require time for observation and evaluation. A strong partnership between the ED and the internal medicine department could help to reduce ED overcrowding by improving care pathways.

Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy

BackgroundEmergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide.This retrospective cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “Diagnostic Anticipation” (DA), which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians.MethodsIn the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the DA protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. A retrospective cohort study on DA impact was conducted. Using ED electronic data, LOS independent predictors (age, sex, NEDOCS and Priority Color Code, imaging tests, specialistic consultations, hospital admission) were evaluated through multiple regression.ResultsDuring the weeks when DA was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 min for chest pain, but longer by 15.7 min for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority, specialist consultations, imaging test, hospitalization and ED crowding, the difference in visit time was significant for chest pain only (p < 0.001).ConclusionsThe impact of DA varied by patients’ condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status.

Состояние законности при применении меры пресечения в виде заключения под стражу

Based on the analysis of statistical indicators of Prosecutor's office work on supervision on implementation of laws by administrations of detentions, the main problems prevailing in detention centers and related with application of a preventive measure as a pre-trial detention against suspects and accused of committing crimes are given in the article. The analysis of the activity of the European court of human rights on consideration of Russian citizens claims about violations of the Federal law of 15.07.1995 No. 103-FZ "About incarceration of suspects and accused of committing crimes" is carried out, as well as measures taken by the Russian Federation to eliminate them. The causes of overcrowding in remand centers occurred in Moscow, Moscow region and a number of other regions are analyzed. The author made suggestions to improve current legislation. The article contains recommendations to prosecutors supervising the implementation of laws by administrations of pre-trial detention facilities, as well as the preliminary investigation of criminal cases.

CURB THE VENGEANCE: Laws on minimum sentencing and parole spell worsening prison conditions

Since 1995, prison overcrowding has mainly been caused by the massive increase in the number of awaiting trial prisoners. Attempts to reduce these numbers have met with some success. However these efforts are nullified by an increase in the number of sentenced prisoners. Legislation passed in 1997 providing for minimum sentences is now the main cause of overcrowding. The situation will be exacerbated by changes to the release policy as per sections 73 to 82 of the Correctional Services Act 111 of 1998 which came into effect on 1 October 2004.

Prison Reforms System and Inmate's Welfare in Nigeria

The dilapidation state of the Nigeria prisons demonstrates a condition that cannot guarantee the reformatory process of the inmates. This can be attributed to the disregard for the welfare of the inmates and failure to implement the prison reforms recommendations. The paper examined the effectiveness of prisons reforms on the welfare of inmates in Ado Ekiti and Olokuta prisons in Ekiti and Ondo States respectively. The study employed a descriptive survey research design with the use of a structured questionnaire to obtain information from the inmates. Multi stage sampling technique was adopted to select the respondents (inmates) from the two prisons. Data for this study were analysed using descriptive statistics and chi square to test the hypothesis formulated for the study. The study revealed that poor administration of the criminal justice systems and unethical practices of the Nigeria police force in Nigeria resulting to high number of inmates awaiting trials are the major causes of overcrowding of the prisons. Therefore, overcrowding constitute a major threat to the welfare of the inmates. In addition the study revealed that prison reforms have a significant impact on the welfare of the inmates in Ado Ekiti and Olokuta. The study recommended government intervention in the implementation of the previously recommended prison reforms, constant supervision of the prisons by the Minister of interior and allocation of funds for provision of infrastructure to cater for the needs of the Nigeria Prison Service.

Partnering Effectively With Inpatient Leaders for Improved Emergency Department Throughput

The boarding of patients is a root cause of overcrowding in a majority of emergency departments (EDs) nationwide. It reduces capacity to treat ED patients, decreases bed utilization, and compromises quality, safety, and the patient experience. Because of its systemic nature, it can only be effectively addressed through attention and commitment by all stakeholders. Once emergency departments have addressed throughput challenges they can solve on their own, they are ready to focus on proactive communication and teamwork with inpatient leaders to identify and transfer potential admissions more efficiently. No-delay nurse reports are an important tool to reduce time from admit orders to arrival on patient units. An effective hospital-wide flow committee also removes barriers for admitting patients quickly from the emergency department and addresses a revised January 1, 2014, Joint Commission standard that requires goal setting and measurement to mitigate and better manage the boarding of patients. This article discusses who should attend, the scope of the committee charter, how to use a hospital-wide throughput dashboard to measure results, and includes a sample agenda. It is recommended that the committee also assess and evaluate the effectiveness of the surge plan at least every three years to ensure that it meets goals identified by the committee. This article also shares best practices associated with two key tactics to support an effective hospital-wide throughput committee: inpatient bed huddles to expedite inpatient admissions and inpatient leader rounding, where the inpatient leader rounds on boarded ED patients to ensure safety and quality while also establishing ownership for the transition.

Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

SUMMARYObjectivesIn this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED.MethodsWe analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined.ResultsA total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes.ConclusionsSimilar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio.

A study of disease pattern in patients presenting in the emergency department of a tertiary hospital catering to industrial workers

Emergency department (in a health care facility) is a section of an institution that is staffed and equipped to provide rapid and varied emergency care, especially for those who are stricken with sudden and acute illness or who are the victims of severe trauma. This study analyzed the disease pattern of patients presenting to the emergency department of a tertiary care insurance based hospital in Delhi. The results showed maximum patients attended were under the Medicine and Surgery discipline. A large proportion of these patients were non emergency cases that could have been managed in the Outpatient Department (OPD). As the cause of overcrowding of the hospital emergency department was attributed to the number of people presenting to the emergency department with non emergent problems it discusses the steps that can be taken to better channelize the use of emergency medical services.

Perception of Komfo Anokye Teaching Hospital Emergency Centre staff on acuity of patients” presentation and appropriateness of attendance

Introduction Emergency Centre (EC) overcrowding influences patient outcomes, use of resources, staff morale, and patient satisfaction. Inappropriate attenders contribute to overcrowding in the EC. Patel found that 24.5% of patients who present to EC do not require emergency care in Canada. The EC of Komfo Anokye Teaching Hospital has overcrowding challenges and health workers' perception of causes of overcrowding may inform their approach to care of emergency patients. The aim was to describe EC staff perception of acuity of presentation and appropriateness of attendance of emergency patients. Methods 95 EC staff comprising 34 physicians and 61 nurses were asked to complete a structured questionnaire to assess perceptions of appropriateness of patients presenting to the EC. Staff sampled could participate in the study if they had previously worked or were currently working in the EC. Answers given on the questionnaire were analysed using STATA 11.0. Results 55.8% of staff thought that walk-in patients attended the EC more frequently than referred patients. 50.5% of staff thought that referred patients often presented with acute conditions and a similar number (49.5%) thought that for walk-in patients. 67% of staff had turned patients away from the EC when they felt their attendance was inappropriate. Of these, 84.2% had turned away more walk-in patients than referred patients. 66.2% of staff thought that referred patients, though often appropriate attenders were frequently triaged to lower than expected acuity category. Discussion Staff in this study were not unanimous on the acuity of presentation of walk-in patients and referred patients. Walk-in patients were more likely turned away from the EC. Though perception of staff may hold inherent weakness of objectiveness, this may inform staff attitudes to care for walk-in patients. Negative perceptions of staff on overcrowding in EC could be addressed through staff training and policy directed at reducing EC overcrowding.

Models for Improving Patient Throughput and Waiting at Hospital Emergency Departments

BackgroundOvercrowding diminishes Emergency Department (ED) care delivery capabilities. ObjectivesWe developed a generic methodology to investigate the causes of overcrowding and to identify strategies to resolve them, and applied it in the ED of a hospital participating in the study. MethodsWe utilized Discrete Event Simulation (DES) to capture the complex ED operations. Using DES results, we developed parametric models for checking the effectiveness and quantifying the potential gains from various improvement alternatives. We performed a follow-up study to compare the outcomes before and after the model recommendations were put into effect at the hospital participating in the study. ResultsInsufficient physicians during peak hours, the slow process of admitting patients to inpatient floors, and laboratory and radiology test turnaround times were identified as the causes of reduced ED throughput. Addition of a physician resulted in an almost 18% reduction in the ED Main discharged patient length of stay. ConclusionThe case study results demonstrated the effectiveness of the generic methodology. The research contributions were validated through statistically significant improvements seen in patient throughput and waiting time at the hospital participating in the study.

Incidence of basioccipital hypoplasia in Chiari malformation Type I: comparative morphometric study of the posterior cranial fossa

The chronic tonsillar herniation defining Chiari malformation Type I (CMI) is thought to result from overcrowding of a normally developing hindbrain within a congenitally small posterior cranial fossa (PCF) due to occipital hypoplasia. The goals in the present study were to authenticate the cranioencephalic disproportion in a group of patients with CMI and to discuss new developmental aspects according to which part of the occipital bone was underdeveloped. The authors retrospectively examined a group of 17 patients with CMI. Measurements of osteotentorial and neural structures of the PCF were made on MR images of the brain. The results were compared with findings in 30 healthy controls by using the Mann-Whitney U-test. Dimensions of the neural structures did not differ between the 2 groups of patients. The mean length of the basiocciput was significantly shorter in the CMI group (19.4 mm) compared with the control group (25.7 mm; p = 0.0003). The mean diameter of the foramen magnum was larger in the CMI group, but this difference was not statistically significant. The dimensions of the supraocciput and the mean angle of the cerebellar tentorium were identical in the 2 groups. Data in this study support the idea that occipital hypoplasia is the main cause of overcrowding within the PCF. Basioccipital shortness is a cardinal feature of the resultant shallow PCF and could proceed from a congenital disorder of the cephalic mesoderm of the parachordal plate or occur later in the infancy because of premature stenosis of the sphenooccipital synchondrosis.

Myths versus facts in emergency department overcrowding and hospital access block

Overcrowding occurs when emergency department (ED) function is impeded, primarily by overwhelming of ED staff resources and physical capacity by excessive numbers of patients needing or receiving care. Access block occurs when there is excessive delay in access to appropriate inpatient beds (> 8 hours total time in the ED). Access block for admitted patients is the principal cause of overcrowding, and is mainly the result of a systemic lack of capacity throughout health systems, and not of inappropriate presentations by patients who should have attended a general practitioner. Overcrowding is most strongly associated with excessive numbers of admitted patients being kept in the ED. Excessive numbers of admitted patients in the ED are associated with diminished quality of care and poor patient outcomes. These include (but are not limited to) adverse events, errors, delayed time-critical care, increased morbidity and excess deaths (estimated as at least 1500 per annum in Australia). There is no evidence that telephone advice lines or collocated after-hours GP services assist in reducing ED workloads. Changes to ED structure and function do not address the underlying causes or major adverse effects of overcrowding. They are also rapidly overwhelmed by increasing access block. The causes of overcrowding, and hence the solutions, lie outside the ED. Solutions will mainly be found in managing hospital bedstock and systemic capacity (including the use of step-down and community resources) so that appropriate inpatient beds remain available for acutely sick patients.

Environmental and Resource Degradation Associated with Small‐Scale Enterprise Clusters in the Red River Delta of Northern Vietnam

AbstractThe paper reports on an empirical study of the environmental and resource degradation observed in small‐scale handicraft clusters in the Red River Delta of northern Vietnam. Most entrepreneurs in these clusters face important challenges, including depletion of natural resources, linked to acute shortages of capital and land. Such issues are identified as the main cause of overcrowding, poor working conditions and extreme environmental degradation. The study also highlights some industrial ecology practices at the enterprise level, and assesses the role played by the government in providing incentives for enterprises to invest in new technology and pollution control. Drawing from the analysis of a questionnaire survey of 56 handicraft enterprises, the study identifies the major constraints they encounter in adopting new environmentally clean technologies and engaging in environmental management. Shortage of capital and lack of knowledge about the benefits of new technologies were viewed as the most important barriers, followed by shortage of skilled workers, poor market conditions and scarcity of land appropriate for industrial production.