ACEM policies: - [Position on Access Block](x-devonthink-item://FF2FE76D-3F09-4ADB-AD7F-651BE381CD75) - [position on ED overcrowding](x-devonthink-item://08A6D68A-8721-4518-A028-3D1B1D234534) - [Position on Ambulance Ramping and diversion](x-devonthink-item://B0008F27-99D7-49F1-A243-B18F561AB2D0) # Definitions - *ED overcrowding* - Emergency department overcrowding refers to the situation where ED function is impeded because the number of patients exceeds either the physical and/or staffing capacity of the ED, whether they are waiting to be seen, undergoing assessment and treatment, or waiting for departure - *Access block* - Access block refers to the percentage of patients who were admitted or planned for admission but discharged from the ED without reaching an inpatient bed, transferred to another hospital for admission, or died in the ED whose total ED time ==exceeded eight hours== - *total access block time* - Total access block time refers to a total ED time (or length of stay) that exceeds eight hours for a patient who was admitted. This includes patients who were planned for an admission, but were discharged from the ED without reaching an inpatient bed, or transferred to another hospital for admission, or who died in the ED - *ambulance ramping* - Ambulance ramping occurs when ambulance officers and/or paramedics are unable to complete transfer of clinical care of their patient to the hospital ED within a clinically appropriate timeframe, specifically due to lack of an appropriate clinical space in the ED. In some jurisdictions, ambulance ramping is also referred to as ‘off-stretcher time delays’ or ‘ambulance turnaround delays’. # common questions What are the common causes of ED overcrowding? 1. Access block 2. Increased patient numbers & complexity 3. increased patient evaluation 4. Delays in referral 5. Delays in other services (allied health, path, radiology, inpatient) 6. Staff skill/numbers 7. ED design and size What are the consequences of ED overcrowding? 1. reduced quality of clinical care 2. increased waiting times 3. increased rate of DNW 4. reduced symptom control 5. reduced patient perception of clinical care What is access block? \>8h from time of ED arrival to discharge to hospital bed What causes access block? 1. reduced number of IP beds 2. Increasing specialisation of inpatient wards 3. Aged care issues- availability of step down facilites 4. Emergency vs elective activity (unbalanced in favour of elective) 5. Ineffective discharge planning *Not caused by GP patients or low acuity ED patients* What are the negative effects of access block? 1. Increased LOS 2. Increased workload for ED staff 3. Increased mortality 4. Increased waiting times & DNW 5. Reduced quality of care 6. Negative impact of staff morale 7. Increased complaints 8. OH&S risk 9. Infectious diseases risk of overcrowding List some of the solutions to access block: 1. ED is only a small part of the solution 2. Increase number of beds available at all levels of care 3. Aim for hospital bed occupancy of 85% (target for effective flow) 4. Improve ED senior clinician decision making, SSU, accelerated pathways, access to diagnostics 5. Improve community interventions- outreach, HITH 6. Improve ward discharge processes, transit lounge use, allied health input etc 7. Increase post acute care services- community beds