The hospital overcrowding is a worldwide problem with a great impact on patients health, satisfaction, and staff productivity. It is triggered by the imbalance between the demand for hospital services and the hospital capacity to provide them. Overcrowding is a multifactorial phenomenon, and its resolution requires a comprehensive strategy that includes microlevel interventions as well as macrolevel ones.
Overcrowding is characterized by the presence of more patients than available ED treatment beds, resulting in extended wait times that exceed tolerable levels. It affects all the hospital stakeholders, and it may lead to patients abandonment of healthcare in favor of alternative care settings or home. Moreover, it is associated with patient safety issues, such as a greater likelihood of mortality in periods of high overcrowding.
Several authors propose solutions to reduce overcrowding, but they cannot be separated from a correct and precise definition of the phenomenon. The concept of overcrowding can be divided into triggering factors and aggravating factors, which are grouped into input and output factors.
Input factors include ED admissions, patient transfer delays, the lack of hospital beds in general and especially for the patients with specialized needs (geriatric, medical-surgical), and the delay in discharge from the ED to home or community-based care settings. In addition, the overcrowding is exacerbated by the fact that the system can be extremely variable in terms of its capacity to meet patient needs (access block). The variability comes from both natural and scheduled variables: epidemics, peaks of surgical admissions, fluctuating consultant availability on weekends, low discharge rates, and palliative or long-term care intake outside bankers’ hours.
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