Hospital overcrowding is a frequent and major problem, with adverse outcomes for both patients and staff. ED overcrowding is associated with ambulance diversion, long wait times for patients to see physicians, frustration and distress of patients and family members, poor patient satisfaction and increased risks for medical errors.
A number of studies have identified the causes and solutions to hospital overcrowding. These strategies focus on the control of input factors that contribute to overcrowding. In particular, boarding in the ED and the inability to move discharged patients from the ED into hospital beds is an important factor, especially when the available hospital bed capacity is low.
Generally, hospitals operate most efficiently when their occupancy is 85 percent or less. However, overcrowding leads to difficulty in matching ED hallway patients to beds, with the result that many patients are delayed or leave without being seen by a physician (leave without being seen; LWBS).
Moreover, overcrowding in the ED may be caused by self-inflicted hospital processes that affect patient flow and the capacity of the system. A good example is surgeons creating their own surgical schedules, which are unbalanced and contribute to overcrowding in the operating room. A solution to this is to spread the surgery volume evenly over a week. This would increase availability of ED bed space in the beginning and end of the week. In addition, increasing weekend discharges could decrease boarding and improve hospital capacity. These solutions are cost-effective and do not require that hospitals work harder.