A new governance of patient flows for hospital and community care. Impact on emergency department overcrowding and workload
Eugenia Dal Bo et al.
What the paper says
Emergency Department (ED) overcrowding is a global challenge, and although tailored local interventions are recommended, their effectiveness remains unclear. This retrospective study evaluated the impact of patient flow governance interventions on ED overcrowding at a large academic hospital. A three-phase (input-throughput-output) model was adopted to analyze factors affecting both static and dynamic indicators of ED overcrowding. Two 6-month periods (2019 vs 2023) were compared, accounting for organizational changes implemented between 2019 and 2022. Over 80% of ED visits involved lower-acuity conditions, and more than 40% of patients were aged over 65 years. ED stays longer than 24 h increased by 637%, whereas medical ward admissions decreased by 31.2% and the daily average number of off-unit admissions declined by 94.3%. The ED discharge rate rose by 3.3%, accompanied by a 200% increase in transfers of frail patients to community facilities. The overall self-discharge rate fell by 3.4%, even though the proportion of patients leaving before being seen increased by 15%. Organizational strategies focusing on throughput and output were associated with fewer hospital admissions and a substantial reduction in off-unit admissions, but these gains came at the cost of increased ED overcrowding and workload.
Evidence weight
Balanced mode · F 0.40 / M 0.15 / V 0.05 / R 0.40
| F · citation impact | 0.50 × 0.4 = 0.20 |
| M · momentum | 0.50 × 0.15 = 0.07 |
| V · venue signal | 0.50 × 0.05 = 0.03 |
| R · text relevance † | 0.50 × 0.4 = 0.20 |
† Text relevance is estimated at 0.50 on the detail page — for your query’s actual relevance score, open this paper from a search result.