Overcrowding of accident & emergency units: is it a growing concern in Nigeria?

Abstract

Background: The inability of the Nigeria's Accident and Emergency Departments (AED) to meet current demands is growing among the public and health care professionals. The data supporting perceptions of insufficient capacity are limited. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria. Materials and Methods: This was a cross sectional, descriptive study carried out among AED staff of 3 referral teaching hospitals in Nigeria, using a pre-tested and validated structured questionnaire. Results: The analysis of the 267 AED staff revealed 20-56years (36.40+5.1 mean) age range. One hundred and twenty eight (47.9%) were males, 139 (52.1%) females. Two hundred and fifty nine (97%) agreed that an AED should have a bed capacity of 21-30. Agreement to AED overcrowding in Nigeria was quite considerable. The frequency of AED overcrowding per week was 4-7 times. The average bed occupancy level was 3.25. Agreed common causes of prolonged AED admissions were to be a high volume of critically ill patients, Delayed transfer of patients to the wards, delay in theatre operation, delay in radiological investigations and exceptionally high proportion of patients requiring admission in AED. Also, long pre-review waiting time and haematological delays were more causes. The average waiting time for victims to be seen was 29.7minutes. Conclusion: There are many causes of AED overcrowding in this environment. However, improving AED bed management, better organized and diligent discharge planning, and reducing access block should be a priority to reduce AED overcrowding

Emergency Department Waiting Times and Determinants of Prolonged Length of Stay in a Botswana Referral Hospital

“…They may also be the only readily available and accessible means of medical care for patients. The departments therefore occupy a crucial position in the medical care continuum [7]. Improving the performance of emergency departments should be a public health priority since the demand for emergency care is increasing annually across the globe and Botswana is no exception [8].…”

A qualitative study of health care providers’ perceptions and experiences of patients bypassing primary healthcare facilities: a focus from Nigeria

“…8 However, despite the provision of care in three tiers, the Nigerian healthcare referral system has continued to be a challenging area, with patients utilising the higher levels of care as they deem fit. 8,9 Some of the Nigerian healthcare indices have persistently remained poor, for example, the probability of dying at under-five as at 2016 was 120/1000 live births, and the life expectancy was 55 for males and 56 for females. 10 Also, the maternal mortality ratio of 917/100,000 live birth is one of the highest in the world.…”

“…[18][19][20] As such, the secondary and tertiary facilities have become overcrowded with patients that could have been easily managed at the PHC facilities. 5,9 Notably, healthcare delivery differs from one setting to another. Thus, the problem concerning the bypass of primary to higher levels of care takes different forms based on the context.…”

Analysis of Emergency Department Presentations due to Injuries From Motor Vehicle Crashes and Pedestrian Strikes

“…Evidence indicates that the use of emergency healthcare services is increasing due to injuries from motor vehicle crashes. However, the capacity of EDs has increased to meet this high demand because it is difficult to establish a balance between ED capacity and necessity [2]. Overly crowded EDs lead to undesired outcomes for patients, providers, healthcare systems, and society.…”