Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions

Abstract

It is certain and established that overcrowding represents one of the main problems that has been affecting global health and the functioning of the healthcare system in the last decades, and this is especially true for the emergency department (ED). Since 1980, overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care. The more recent COVID-19 pandemic contributed to the accentuation of this phenomenon, which was already well known and of international interest. Considering what would appear to be a trivial definition of overcrowding, it may seem simple for the reader to hypothesize solutions for what seems to be one of the most avoidable problems affecting the hospital system. However, proposing solutions to overcrowding, as well as their implementation, cannot be separated from a correct and precise definition of the issue, which must consider the main causes and aggravating factors. In light of the need of finding solutions that can put an end to hospital overcrowding, this review aims, through a review of the literature, to summarize the triggering factors, as well as the possible solutions that can be proposed.

Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain

“…The rise in complication rates may be explained by a mixture of changes in internal processes, high staff turnover, including among resident physicians, and healthcare reorganisation, which can be added to the effect of attending to patients with more severe diseases and greater management difficulties. In addition, the overcrowding in emergency departments may have also contributed to longer waiting times for hospitalisation as all patients had to be triaged before being hospitalised in a non-COVID unit [ 36 ]. To provide useful information at the hospital level, promote specific actions for improvement, and fine tune current contingency plans, there is a need for more in-depth analysis of patient groups identified as showing an increase in complications (i.e., musculoskeletal system diseases) or greater in-hospital mortality (i.e., diseases of the digestive system, kidney and urinary tract diseases, or subcutaneous skin and breast diseases).…”

Pathophysiology and Therapy of High-Altitude Sickness: Practical Approach in Emergency and Critical Care

“…Regardless of how acclimatization limits are exceeded, high-altitude hypoxemia results. Hypobaric hypoxia and hypoxemia are the pathogenetic precursors of high-altitude disease [ 31 , 55 , 56 ].…”

Telemedicine in Emergency Medicine in the COVID-19 Pandemic—Experiences and Prospects—A Narrative Review

“…Numerous studies in emergency medicine and telehealth have investigated the use of telemedicine in prehospital/pre-ED settings [7][8][9][10]. A significant increase in the number of patients admitted with SARS-CoV-2 infections was found during the early stage of the COVID-19 pandemic, which indicates difficulty in obtaining medical help at the beginning of the pandemic, before the implementation of pre-hospital teleconsultations [9].…”

“…A significant increase in the number of patients admitted with SARS-CoV-2 infections was found during the early stage of the COVID-19 pandemic, which indicates difficulty in obtaining medical help at the beginning of the pandemic, before the implementation of pre-hospital teleconsultations [9]. Tele-triage decreased waiting time for treatment, and thus reduced the overcrowding resulting from the input factors [10].…”

“…Remote patients' evaluation [11,12,[21][22][23][24] Misdiagnosis or delay in diagnosis because of lack of a physical examination [55,56] Reduction of the exposure to COVID-19 by limiting personal contact [7,20,32,33] Lack of learning of clinical, practical, and hands-on medical skills by medical staff and students [49] Triage acceleration [6,11,12] Lack of health care providers' preparation and professional scepticism [58,60] Reduction of the overcrowding in EDs [10] Lack of patient readiness and low patient satisfaction [58] Saving personal protective equipment [18,20] No access to digital tools [54] Telemedical support of medical caregivers and decision-making processes [16,17,30,31,50] Problems with protecting the privacy and confidentiality of patient data [61] Fast communication with foreign-speaking patients [21,22] Lack of telehealth in the curricula study programs [62] Closer and permanent patient monitoring in ICUs and at home. [25,26,28,29,36,37] Regulatory, legal, and administrative barriers [58,60,63] Better coordination of emergency systems…”