Patient Flow at Emergency Department – The Safety Net of Health Care System

Abstract

BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the safety net of the health care system. Unfortunately the increasing problem of crowding has strained this safety net to the breaking point according to some recent reports.

OBJECTIVE: To study the patient flow at Emergency Department of a tertiary care centre. METHODS: This prospective study was carried over a period of two weeks at SKIMS in the month of December 2011.

RESULTS: Of 175 patients attending on an average within twenty four hours to SKIMS emergency department, 22.3% of patients were admitted. 50 patients on an average were being treated at ED reception, the space which is meant for maximum of 16 patients. The hospital crowding was primarily regarded as a consequence of inadequate medical resources. Patients were seen more likely to leave without being seen when ED occupancy exceeded 100% of the total capacity. The shifting of admitted patients from ED depended on throughput factors in the parent speciality. It was also observed that patients who historically would be admitted through OPD would also find entry through ED.

CONCLUSION: ED crowding is a local manifestation of a systemic disease. The focus has to be multipronged i.e., on Input, Throughput and Output Factors. While as control on input demands wider participation at multicentric community levels, hospitals can focus on the other two class of factors. There has to be clear focus on efficient use of inpatient resources. JMS 2012;15(2):132-35