Addressing overcrowding in an emergency department: an approach for identifying and treating influential factors and a real-life application

Nurses' Perception on the Hindrances of Triage System in Emergency Unit

Background: Despite the fact that several triage tools have been implemented globally, emergency care, including the triage system, is often one of the weakest parts of the health system in developing countries, as compared to developed countries. Moreover, emergency centers in African countries are very busy, often flooded by high load of trauma patients, chronic medical conditions, acute medical emergencies, and HIV-related conditions. These disease conditions precipitate the reasons for the prioritization of patients. In South Africa, studies conducted on the use of triage by nurses revealed that most patients are satisfied with the Nurse-led triage service provided in emergency departments (EDs). At the same time, some Nurses also see the South African Triage Scale (SATS) as one of the easiest Nurse-led triage tools. Aim: The study aimed at identifying the factors hindering the effective process of triage during care provision at a selected public hospital in KwaZulu-Natal (KZN). Methods: This study utilized a cross-sectional survey, employing a nonprobability convenience sampling to recruit its respondents. The recognition primed decision model formed the framework of the study. Ethical clearance was obtained from the University of KwaZulu-Natal Ethics Review Board, and ethics principles were carefully observed throughout the study. Results: Out of the 100 respondents, 89% (89) of the respondents perceived that various factors still impede the progress of triage, while 11% (11) of the respondents perceived that no factor impedes the progress of triage. Conclusion: The study indicates that several factors still hinder the effective process of triage. Based on the findings of the study, factors like overcrowding, Nurses waiting for doctors when they know what to do, lack of continuous professional development on triage system, inadequate experience, lack of confidence, and lack of adequate training on triage still impede the efficient triage system.

Association between Boarding of Frail Individuals in the Emergency Department and Mortality: A Systematic Review

(1) Background: Older patients who attend emergency departments are frailer than younger patients and are at a high risk of adverse outcomes; (2) Methods: To conduct this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We systematically searched literature from PubMed, Embase, OVID Medline®, Scopus, CINAHL via EBSCOHost, and the Cochrane Library up to May 2023, while for grey literature we used Google Scholar. No time restrictions were applied, and only articles published in English were included. Two independent reviewers assessed the eligibility of the studies and extracted relevant data from the articles that met our predefined inclusion criteria. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the studies; (3) Results: Evidence indicates that prolonged boarding of frail individuals in crowded emergency departments (Eds) is associated with adverse outcomes, exacerbation of pre-existing conditions, and increased mortality risk; (4) Conclusions: Our results suggest that frail individuals are at risk of longer ED stays and higher mortality rates. However, the association between the mortality of frail patients and the amount of time a patient spends in exposure to the ED environment has not been fully explored. Further studies are needed to confirm this hypothesis.

Overcrowding in Emergency Department: Causes, Consequences, and Solutions—A Narrative Review

Overcrowding in Emergency Departments (EDs) is a phenomenon that is now widespread globally and causes a significant negative impact that goes on to affect the entire hospital. This contributes to a number of consequences that can affect both the number of resources available and the quality of care. Overcrowding is due to a number of factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a decrease in the ability to provide critical services in a timely manner to patients suffering from medical emergencies. This phenomenon results in the Emergency Department reaching, and in some cases exceeding, its optimal capacity. In this review, the main causes and consequences involving this phenomenon were collected, including the effect caused by the SARS-CoV-2 virus in recent years. Finally, special attention was paid to the main operational strategies that have been developed over the years, strategies that can be applied both at the ED level (microlevel strategies) and at the hospital level (macrolevel strategies).

Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies

Problems related to patient scheduling and queueing in emergency departments are gaining increasing attention in theory, in the fields of operations research and emergency and healthcare services, and in practice. This paper aims to provide an extensive review of studies addressing queueing-related problems explicitly related to emergency departments. We have reviewed 229 articles and books spanning seven decades and have sought to organize the information they contain in a manner that is accessible and useful to researchers seeking to gain knowledge on specific aspects of such problems. We begin by presenting a historical overview of applications of queueing theory to healthcare-related problems. We subsequently elaborate on managerial approaches used to enhance efficiency in emergency departments. These approaches include bed management, fast-track, dynamic resource allocation, grouping/prioritization of patients, and triage approaches. Finally, we discuss scientific methodologies used to analyze and optimize these approaches: algorithms, priority models, queueing models, simulation, and statistical approaches.