Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions

Hoot, Nathan R.; Aronsky, Dominik

doi:10.1016/j.annemergmed.2008.03.014

Cited by 1,273 publications

(1,041 citation statements)

References 119 publications

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“…Many studies in the US have sought to understand reasons for the increased crowding in emergency departments (Hoot and Aronsky 2008). It has been hypothesised that uninsured patients who are unable to access primary care delay care until their condition deteriorates to the point that they are forced to turn to hospitals or emergency departments.…”

Section: Literature Reviewmentioning

confidence: 99%

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Dolton

Pathania

2016

Journal of Health Economics

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Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

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Section: Literature Reviewmentioning

confidence: 99%

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Dolton

Pathania

2016

Journal of Health Economics

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“…Emergency department (ED) overcrowding has become a serious and growing problem common around the world with significant worldwide public health problems [1]. Overcrowding is the product of several hospital internal and external factors, and the most relevant are the insufficient access to hospital beds, and shortage of ED nursing and physician staff.…”

Section: Introductionmentioning

confidence: 99%

Overcrowding in emergency department: an international issue

Somma

Paladino

Vaughan³

et al. 2014

Intern Emerg Med

346

235

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Overcrowding in the emergency department (ED) has become an increasingly significant worldwide public health problem in the last decade. It is a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, as for example it occurs in mass casualty incidents, but also in other conditions causing a shortage of hospital beds. In Italy in the last 12-15 years, there has been a huge increase in the activity of the ED, and several possible interventions, with specific organizational procedures, have been proposed. In 2004 in the United Kingdom, the rule that 98 % of ED patients should be seen and then admitted or discharged within 4 h of presentation to the ED ('4 h rule') was introduced, and it has been shown to be very effective in decreasing ED crowding, and has led to the development of further acute care clinical indicators. This manuscript represents a synopsis of the lectures on overcrowding problems in the ED of the Third Italian GREAT Network Congress, held in Rome, 15-19 October 2012, and hopefully, they may provide valuable contributions in the understanding of ED crowding solutions.

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“…3 Common reasons for such frequent use include pain, chronic physical and mental illness, and substance abuse. 1,2,4,5 Frequent ED users are mainly men, are between 40 and 50 years of age, are sicker and have higher rates of mortality than occasional ED users.…”

Section: Introductionmentioning

confidence: 99%

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

et al. 2016

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BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention--compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective.KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = −0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

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Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions

Cited by 1,273 publications

References 119 publications

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Overcrowding in emergency department: an international issue

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

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