Exit block in emergency departments: a rapid evidence review

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Abstract

Exit block (or access block) occurs when 'patients in the ED requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame'. Exit block is an increasing challenge for Emergency Departments (EDs) worldwide and has been recognised as a major factor in leading to departmental crowding. This paper aims to identify empirical evidence, highlighting causes, effects and strategies to limit exit block.

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Most cited references 23

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Predicting emergency department admissions.

Justin Boyle, Melanie Jessup, Julia Crilly … (2012)

To develop and validate models to predict emergency department (ED) presentations and hospital admissions for time and day of the year.

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Entry overload, emergency department overcrowding, and ambulance bypass.

D Fatovich, Fred Hirsch (2003)

To describe an experience of emergency department (ED) overcrowding and ambulance bypass. A prospective observational study at Royal Perth Hospital, a major teaching hospital. Episodes of ambulance bypass and their characteristics were recorded. From 1 July 1999 to 30 June 2001, there were 141 episodes of ambulance bypass (mean duration 187 min, range 35-995). Monday was the most common day with 39 (28%) episodes. Entry block alone was the most common reason bypass was activated (n=38, 30.4%). The mean number of patients in ED at these times was 40 (occupancy 174%), including nine in the corridor, seven awaiting admission, and 14 waiting to be seen. Episodes attributable to entry block were typically preceded by a presentation rate of >/=10 patients per hour for >/=2 hours (OR 6.2, 95% CI 4.3 to 8.5). Mid-afternoon to early evening was the most common time for activation. Ambulance bypass is increasing in frequency and duration. Entry overload resulting in entry block results from overwhelming numbers of patients presenting to the ED in a short space of time. Entry block impairs access to emergency care. Unless something is done in the near future, the general public may no longer be able to rely on EDs for quality and timely emergency care. A "whole of system" approach is necessary to tackle the problem.

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Adding more beds to the emergency department or reducing admitted patient boarding times: which has a more significant influence on emergency department congestion?

R Khare, Martin Lucenti, Gilles Reinhardt … (2009)

We evaluate a computer simulation model designed to assess the effect on emergency department (ED) length of stay of varying the number of ED beds or altering the interval of admitted patient departure from the ED. We created a computer simulation model (Med Model) based on institutional data and augmented by expert estimates and assumptions. We evaluated simulations of increasing the number of ED beds, increasing the admitted patient departure and increasing ED census, analyzing potential effects on overall ED length of stay. Multiple sensitivity analyses tested the robustness of the results to changes in model assumptions and institutional data. With a constant ED departure rate at the base case and increasing ED beds, there is an increase in mean length of stay from 240 to 247 minutes (95% confidence interval [CI] 0.8 to 12.6 minutes). When keeping the number of beds constant at the base case and increasing the rate at which admitted patients depart the ED to their inpatient bed, the mean overall ED length of stay decreases from 240 to 218 minutes (95% CI 16.8 to 26.2 minutes). With a 15% increase in daily census, the trends are similar to the base case results. The sensitivity analyses reveal that despite a wide range of inputs, there are no differences from the base case. Our computer simulation modeled that improving the rate at which admitted patients depart the ED produced an improvement in overall ED length of stay, whereas increasing the number of ED beds did not.

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Author and article information

Journal

Title: Emergency Medicine Journal

Abbreviated Title: Emerg Med J

Publisher: BMJ

ISSN (Print): 1472-0205

ISSN (Electronic): 1472-0213

Publication date Created: December 14 2016

Publication date Created: January 2017

Publication date (Print): January 2017

Publication date (Electronic): October 27 2016

Volume: 34

Issue: 1

Pages: 46-51

Article

DOI: 10.1136/emermed-2015-205201

PubMed ID: 27789568

SO-VID: 54b8fb0d-16df-4af5-8d3f-7e59c9f1507a

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Exit block in emergency departments: a rapid evidence review

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Most cited references 23

Predicting emergency department admissions.

Entry overload, emergency department overcrowding, and ambulance bypass.

Adding more beds to the emergency department or reducing admitted patient boarding times: which has a more significant influence on emergency department congestion?

Author and article information

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