Associations Between Hospital Occupancy, Emergency Department Function and Ambulance Delays, With Modelled Mitigation Strategies: Evidence From Acute Queensland Hospitals.

Abstract

This editorial highlights three studies that collectively offer a roadmap towards system-level improvement in access, flow and quality of care. These studies used linked data from several Queensland hospitals and explored emergency department (ED)-hospital capacity associations with ambulance, ED and hospital dysfunction. One study found ED occupancy was strongly associated with ambulance dysfunction (ramping, response times). The second study associated hospital occupancy with ED dysfunction. Larger hospitals with occupancies above 85%-90% became dysregulated with rapid overcrowding. The modelling study in three tertiary hospitals reported that reduced admissions (ED or elective procedures), improved discharges (earlier, quicker community discharge, home care) and flexible bed use (any ward, over-census) improved flow. Diverting general practice-type attendances and weekend surgery seemed ineffective. Rapid, adequate flexible admitting capacity seems important for safe, efficient hospital-ED care and ambulance function.