While conducting research into the flow of patients through an Emergency Department (ED), we analysed a ten-year dataset of patient ages and waiting times. This analysis gave insight into seasonal and age-related factors in ED overcrowding and the findings were recently published in the Irish Medical Journal available here.
To anyone familiar with the almost annual media reporting and discussion on winter trolley crises, some of the findings can at first seem counterintuitive. We had expected to see the highest ED attendance numbers over the winter months, when flu and other illnesses require people to make their way to their local ED. However, the data showed that ED attendance was less seasonal than anticipated and, in fact, the number of patients presenting to the ED was highest in the summer months. A key consideration here is that the patients in an ED at any given time fall into two high-level cohorts: those waiting for and receiving the emergency care they require; and those who have finished their emergency care, have been deemed to require admission and are waiting for a bed. The people entangled in the winter trolley crisis are those in the second cohort (often referred to as “boarders”) who suffer long stays on a hospital trolley in ED while they wait for a ward bed to become available.
In a scenario where there is high utilisation of hospital beds, those with the most specific care requirements will be most affected by the scarcity of beds and will wait the longest for a suitable option to become available. This unfortunately tends to be older patients who, as Baumbusch & Shaw (2011) point out, are very often frail and suffering from multiple co-morbidities and atypical symptoms. It is important for such patients to be allocated a bed in a ward that can cater for their needs so that the best possible medical outcome can be achieved. However when the supply of beds is limited, this will result in a prolonged stay in the ED. Our research illustrated that there is an almost linear relationship between patient age and waiting time for a bed, with approximately a half an hour increase in waiting time for every 10-year increase in patient age, and thereby confirms that older people are most affected by the capacity problems in our hospitals. This in itself is worrying but given that the population in Ireland is ageing significantly (OECD 2013), it highlights an urgent need to plan for the current and future healthcare needs of elderly patients.
Our research has found that the ED is busy all year round and that the increased ED crowding in winter is more of a consequence of longer hospital bed stays associated with the ailments and people typically treated at that time of year. Solutions to the capacity problem include providing a sufficient number of hospital beds but also reducing the length of stay in the acute hospital by ensuring an adequate supply of subsequent care resources and facilities. These are needed so that patients who have completed their acute care can be catered for in an appropriate setting until they are able to be discharged to their own homes and thereby making the acute facilities available in a more timely fashion to those who require them.
Dr Paul Liston
DCU Business School,
Dublin City University
Baumbusch, J. & Shaw, M., 2011. Geriatric emergency nurses: addressing the needs of an aging population. Journal of Emergency Nursing: JEN, 37(4), pp.321–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21741565.
OECD, 2013. Health at a Glance 2013, OECD Publishing. Available at: http://dx.doi.org/10.1787/health_glance-2013-en.