Overcrowding is a global phenomenon, affecting healthcare access and outcomes. It is associated with adverse patient experiences and a negative impact on staff morale. It can also negatively affect hospital finances.
Several strategies have been proposed to reduce hospital overcrowding, but none is likely to address the problem adequately without collaboration across all levels of the institution—from housekeepers to the CEO. In addition to the many micro-level factors, there are some macrolevel factors that determine the extent and duration of overcrowding. These include the presence of exit block (when patients in the ED who require admission to a hospital are unable to gain access to appropriate beds within a reasonable time frame) and the lack of bed availability (which may be due to the decrease in ED admissions or to the closure of hospital beds for other reasons).
Input and flow factors include crowded conditions that result from increased ED use, higher acuity of patients, and delays in service delivery by radiology, laboratory, and ancillary services. The latter can be addressed through staffing and scheduling improvements. A lack of inpatient beds can be overcome through bed smoothing, which includes a transfer policy that increases the number of available beds on weekends.
Output factors, such as the delay in transferring patients from the ED to an appropriate department and to home care, increase overcrowding. They can also be mitigated by early morning discharges from inpatient units. The authors recommend a comprehensive approach to address overcrowding, including internal ED department improvements and system-wide changes, such as the smoothing of elective admissions.