Overcrowding is a hospital-wide issue that impacts patient care, staff morale and productivity, and medical and nursing costs. ED overcrowding is a complex problem with multiple causes, including staff shortages, poor system organization, limited capacity to discharge patients, and inadequate access to community-based healthcare services.
The occurrence of overcrowding in hospitals has been linked to adverse patient outcomes, such as increased morbidity and mortality. Several studies have shown that the severity of crowding in a hospital affects its financial stability. Improving TDI can improve efficiency, enhance quality scores and increase both patient and provider satisfaction.
Hospital overcrowding is the imbalance between demand for emergency care and the capacity of a hospital’s ED to treat all presenting patients [1]. When the ED reaches its physical and staffing capacity, it becomes dysfunctional, with a mismatch between patient arrival rate and clinical service providers. This results in a delay in the initial phase of patient triage and diagnostic evaluation and treatment, leading to long waiting times for patients in corridors and in boarding units.
Boarding is one of the major factors of overcrowding because it impedes the flow of patients through the ED. It has a negative impact on output factors, such as door-to-needle time and the number of patients left without being seen by a physician (LWBS). This increases the LOS and decreases the availability of resources (beds, staff, and diagnostic techniques) for new arrivals, thus promoting the cyclical nature of overcrowding.
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