Reducing Overcrowding at the Emergency Department in Community Hospital at Sisaket Province

Abstract

This research aimed to develop and evaluate the management guidelines to reduce overcrowding in the emergency department (ED) at a community hospital. The guideline development was from input - throughput - output conceptual model of ED. Evidences were searched and synthesized from 10 studies to develop guidelines for reducing overcrowding. The AGREE II was used to measure the value and feasibility of the guidelines developed checking the accuracy of language and content validity = 0.80. Data were collected by purposive sampling of the 25 practitioners and 5,909 patients attending the ED. They were divided into two groups: 3,111 patients in the routine group and 2,798 patients in the experiment group. The study was conducted at a community hospitals during at 16.00 -24.00 p.m. in April - September 2018. It was found that management components to reduce overcrowding at ED included (1) formation of the ED Board of Emergency Quality Management, (2) patient screening, (3) limitation of time duration for assessing emergency patient not to exceed 4 hours, (4) financial and treatment cost payment systems in place, (5) provision of information on self-care after discharge, (6) fast track referral system, (7) laboratory testings at point of care, and (8) application of the ideal ED patient journey models as part of the process concept and outflow of patients in the ED. There was a significant reduction of waiting period after using the guidelines (p<0.05); and the average length of stay became 46.70 minutes (SD =31.95, Min=15 minutes, Max=180 minutes, 95%CI=65.01-66.74). The National Emergency Department Overcrowding Score (NEDOCS Score) decreased from 141-180 points to 101-140 points. The percentage of declined treatment decreased significantly, from 3.05% to 0.89%. Thus, the research demonstrated that the guideline could reduce overcrowding and waiting time to less than 4 hours in the ED at the community hospital.