oa Emergency Department overcrowding and increased length of stay: Identifying the causes in a secondary care general hospital

Background: Emergency Department (ED) is amongst the most crucial departments in the hospital. It receives around 1000 patient/day. ED overcrowding (EDOC) and increased Length of Stay (LOS) are key global issues for more than 20 years, as they have serious repercussions. No measurements have been done to assess the situation nationally.

Methods: The paper used direct observation for seven days to collect patient flow data on ED patients at a secondary care hospital in Kuwait. It calculated wait times and services to identify the major causes of EDOC and increased LOS.

Results: A total number of 6383 patient visits were registered, 1750 of them were referred to the ED observation room. Among these, 210 patients stayed more than 6 hours as a total ED visit time. The aggregated time of the 210 patients was 1918.95 hours. Further analysis revealed that they spent 1078.98 hours as wasted waiting time. (Waiting for a vacant in-patient bed) constituted 52% of that time, (waiting for a consultation reply) constituted 13.3% and (waiting for a radiology request to be executed) constituted 13.29%.

Conclusions: Around one-third of the ED design capacity was utilized by 12% of the ED patients. The wasted waiting time represents 56.2% of the aggregated LOS, and access block to inpatient wards was the primary cause of increased LOS and EDOC. A national-wide measurement project should be considered to assess the exact problem volume, its impact and test solutions, which should eliminate the waits before trying to reduce the service time.