Global ED overcrowding
>> Today Ian of ImpactED nurse blogged, once again, about the dismal working conditions of his overcrowded emergency department. The comment box for the post was filled with tales of similar working conditions from the UK, Australia and the US. It seems EDs are overcrowded all over the world. Common signs of overcrowding are patients 'boarding' in the ED while they await inpatient beds (access block), long wait times for receiving treatment (entry block), patients receiving treatment in hallways due to unavailability of ED beds, ambulance diversion, and patients leaving without treatment.
In the US the problem of ED overcrowding can be attributed to the severe economic rationalization in heathcare in the past decade. From 1993 to 2003, the number of ED visits increased by 26% while the number of EDs decreased by 12.3%. In 2003, the level of ED overcrowding was so high that one ambulance was diverted on average, in the US, every minute.
A number of contributing factors have been found for overcrowding - I like to call these 'internal' and 'external' factors. External factors are those not under the control of hospitals, such as, increased acuity of patients, managed care, increases in elderly patients, and complexity of disease. Internal factors, on the other hand, are those on which hospitals can have some control. Some internal factors leading the overcrowding are unavailability of resources such as nurses, beds and physicians and inefficiently designed patient flows. While government funding and policy level issues are not under the control of hopitals, hospitals certainly can ameliorate the situation by utilizing their limited resources better.
Given that the problem crosses national boundaries, I think internal factors play a larger role than external ones, since varying external factors (as they can be assumed to vary from one coutry to another) seems to have little effect on the severity of the problem. This gives me hope for my own research as well as for EDs grappling with the problem. Hope because my research is not concerned with examining government policy or economic trends in healthcare. I am interested in looking at the internal variables that can be tweaked by hospitals to solve thier own problem. Also because policy level changes can be assumed to take a long time to implement, but changes related to internal factors can be implemented quickly by the hospitals themselves. This leads to the question "What can hospitals do to decrease levels of ED overcrowding given their limited resources?" That is the question I seek to answer with my PhD research.
The more I delve into the problem, the harder it seems to answer this question.
>> Trip to [Teaching hospital] yesterday for a focus group with emergency medicine residents turned out to be futile. BOTH my recorder and [Co-researcher]'s recorder failed. Our recorders have never failed to record before, leave alone at the same time. And ofcourse neither of us were taking notes because we have become too reliant on the recorders. Sigh.
>> One of my favorite bloggers has taken a hiatus from blogging. I have read every post written by Maria in the past 6 years, some several times. Her posts inspire me and give me the strength to go on with my life everyday, maybe because I can relate to her on various levels. We seem to be similar in a lot of ways. Its funny how close you can feel to a complete stanger, thousands of miles away, just by reading their writing everyday. I will miss Maria.
In the US the problem of ED overcrowding can be attributed to the severe economic rationalization in heathcare in the past decade. From 1993 to 2003, the number of ED visits increased by 26% while the number of EDs decreased by 12.3%. In 2003, the level of ED overcrowding was so high that one ambulance was diverted on average, in the US, every minute.
A number of contributing factors have been found for overcrowding - I like to call these 'internal' and 'external' factors. External factors are those not under the control of hospitals, such as, increased acuity of patients, managed care, increases in elderly patients, and complexity of disease. Internal factors, on the other hand, are those on which hospitals can have some control. Some internal factors leading the overcrowding are unavailability of resources such as nurses, beds and physicians and inefficiently designed patient flows. While government funding and policy level issues are not under the control of hopitals, hospitals certainly can ameliorate the situation by utilizing their limited resources better.
Given that the problem crosses national boundaries, I think internal factors play a larger role than external ones, since varying external factors (as they can be assumed to vary from one coutry to another) seems to have little effect on the severity of the problem. This gives me hope for my own research as well as for EDs grappling with the problem. Hope because my research is not concerned with examining government policy or economic trends in healthcare. I am interested in looking at the internal variables that can be tweaked by hospitals to solve thier own problem. Also because policy level changes can be assumed to take a long time to implement, but changes related to internal factors can be implemented quickly by the hospitals themselves. This leads to the question "What can hospitals do to decrease levels of ED overcrowding given their limited resources?" That is the question I seek to answer with my PhD research.
The more I delve into the problem, the harder it seems to answer this question.
>> Trip to [Teaching hospital] yesterday for a focus group with emergency medicine residents turned out to be futile. BOTH my recorder and [Co-researcher]'s recorder failed. Our recorders have never failed to record before, leave alone at the same time. And ofcourse neither of us were taking notes because we have become too reliant on the recorders. Sigh.
>> One of my favorite bloggers has taken a hiatus from blogging. I have read every post written by Maria in the past 6 years, some several times. Her posts inspire me and give me the strength to go on with my life everyday, maybe because I can relate to her on various levels. We seem to be similar in a lot of ways. Its funny how close you can feel to a complete stanger, thousands of miles away, just by reading their writing everyday. I will miss Maria.
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