Hospital overcrowding has become a major health problem for many countries [1]. This problem is mainly due to the aging of the population, a decrease in the number of hospital beds and an increase in the number of patients who require emergency services. In general, ED overcrowding results in access block: patients who are unable to gain access to hospital beds within a reasonable timeframe (defined by the Australasian College for Emergency Medicine as 8 h or less) [2]. This causes delay in patient assessments and treatment initiation. This in turn increases the ED crowding, triggering a vicious cycle.
Various studies have highlighted the importance of implementing solutions to prevent hospital overcrowding. However, proposing such solutions depends on a correct definition of the problem, taking into account the main causes and aggravating factors of this phenomenon.
To analyze the reasons for ED overcrowding, we used data from two consecutive seven day periods, one pre and one post the COVID-19 pandemic, to measure the occurrence of ED access block in the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital (Salerno, Italy). We also assessed the accuracy of NEDOCS and EDWIN indexes in measuring ED overcrowding. The results showed that both indexes have good discrimination for predicting ED overcrowding.
From a clinical point of view, a solution to the ED overcrowding must include throughput, exit block and patient flow factors. To address these problems, we propose that hospitals adopt a new approach to managing the ED. This should involve a more structured and transparent process with clear responsibilities at every level.