Hospital overcrowding is a problem that affects hospital patient flow and quality of care. It also contributes to increased stress and burnout among nurses and to higher turnover rates. A combination of micro- and macro-level strategies has to be implemented in order to address the issue of hospital overcrowding.
Overcrowding is mainly determined by a mismatch between bed supply and demand. As a result of limited availability of beds, patients become stuck in hospitals and especially in the ED, waiting for beds to open up. This situation is aggravated by a delay in discharging patients after completion of their treatment (e.g. due to seasonal illness, surgery scheduling, the safety net or uninsured patients).
Prolonged ED overcrowding leads to increased ER wait times and patient dissatisfaction, and discourages incoming visits (LWBS). It can also encourage boarding, i.e. the admission of patients awaiting hospitalization to non-standard wards, thus prolonging their stay and affecting their care experience (Goulding et al., 2015).
A solution is to increase the number of beds in the ED. This can be achieved through a range of initiatives such as smoothing elective cases, enhanced weekend discharges or telemedicine services. However, the most important measure is to improve ED capacity and ensure that nurses are adequately equipped to work in challenging situations. This requires not only organizational changes but also improved working conditions for staff, including better support and incentives. In this way, overcrowding and boarding could be avoided and patient satisfaction and flow optimized.
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