Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

Abstract

BackgroundEmergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals.MethodsOriginal research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase.ResultsOut of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized.ConclusionED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.

Treat and Release for Patients Requiring Emergency Medical Services

“…The health care systems of many countries around the world are facing ever-increasing emergency department overcrowding. 1,2 In Canada, the number of emergency department visits per year has grown over time and is out of proportion to population growth. 3,4 The growing burden of chronic disease and population aging, shortages of health care providers, an increasing number of visits by patients with serious or complex health conditions, and high volumes of low-acuity presentations (i.e., patients with a relatively low need for urgent medical care) are some of the suspected causes of this major global health care issue.…”

Acil servisten istenen radyolojik görüntüleme incelemelerinin etkinliğinin değerlendirilmesi

“…Acil servise herhangi bir şikayetle gelen her hasta, uygun bir şekilde sorgulanmalı ve acil bir durum varlığı açısından değerlendirilmelidir. 1 Hastaların acil servis personelinden hızlı bir şekilde hizmet alma ve doğru tanı koymaları konusunda beklentileri vardır. Doktorlardan, acil müdahale gerektirmeyen hastaları doğru bir şekilde filtrelemeleri beklenmektedir.…”

“…Doktorlardan, acil müdahale gerektirmeyen hastaları doğru bir şekilde filtrelemeleri beklenmektedir. 1,2 Diğer taraftan acil servisleri etkileyen en kritik konulardan biri yoğunluk sorunudur. Bu yoğunluk, acil servis sunumunu etkileyen çok yönlü bir konudur.…”

“…Bu yoğunluk, acil servis sunumunu etkileyen çok yönlü bir konudur. 1 Bu zorlu ortam, birçok belirsizlikle birlikte, acil doktorlarının klinik tanılardaki hataları en aza indirmek için ileri teknolojiye daha fazla ve klinik becerilerine daha az güvenmelerine yol açmıştır. 3 Teşhis koymada görüntülemenin öneminin artması, bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) gibi görüntüleme yöntemlerine kolay ulaşabilme imkanıyla birlikte acil servislerde BT başta olmak üzere üst düzey görüntüleme yöntemlerinin kullanımını da arttırmıştır.…”

Emergency Department Crowding of a General Hospital in Alexandria, Egypt

“…(2) Overcrowded ED could be brought by multiple factors. The number of ED visits may rise as it is available after the working hours of primary care centers, (3)(4)(5)(6)(7) a place to seek medical care without scheduled appointment or if non-insured, (5,8) a facility with rapid diagnostic modalities and early initiation of therapy and patients can expect a higher possibility to be admitted to the hospital by the ED attendant. (7,9,10) Other factors for crowding are shortage of resources including staff, beds, diagnostic resources and boarding of admitted patients.…”