Every day, all over Australia patients that have been treated in Emergency Departments (ED’s) and need admitting to hospital are moved out into ED corridors because there are no ward beds available.
Nationally, emergency department waiting times are steadily rising.
A recent report (pdf) released by the Australian Institute of Health and Welfare shows that for 2017-18 there were more than 8 million presentations to public hospital emergency departments—an average of about 22,000 each day.
Overall, about 72% of these presentations were seen ‘on time’ for their urgency (triage) category, a decrease from 75% in 2013–14.
Patients waiting for a ward bed typically wait in the ED a total of somewhere between 4 to 11 hrs (with critically unwell and complex care patients usually waiting at the longer end of this spectrum).
However, it is not uncommon for some patients to spend days in the emergency department waiting for a ward bed.
There are a few reasons for this.
But one of the most disruptive causes is known as ‘Access Block’.
Why am I being moved out to a bed in a corridor?
The hospital has reached capacity and does not currently have a ward bed available for you. This is known as access block.
Everyone is working as hard as they can to get you transferred to an appropriate ward as soon as possible.
But in order to stop the ED completely filling its beds with patients waiting for admission (making it impossible to treat the arriving patients), the difficult decision has been made to move you to a corridor or other non-clinical space, to free up acute care beds.
Is anyone actually looking after me now?
Absolutely. The emergency department should have arranged for a nurse to be caring for you whilst you are in the corridor. Sometimes this will be a nurse that has been called in especially. At other times nurses will care for corridor patients on top of their usual workloads.
As you have been admitted under an inpatient physician and medical team they are also responsible for your care now and should come to see you at some point.
Why cant anyone tell me how long this will be for?
Doctors, nurses, and administrators are all working constantly to open the hospitals capacity and improve the flow of patients admitted from the ED to the wards. But this is a complex problem with many variables and it is difficult to predict when a bed space will become available for you.
Am I safe in this corridor?
Yes and no.
Hospitals will adamantly reassure the public that patients waiting in ED corridors remain safe. And yes, there is no other space in the hospital that has more skilled and experienced doctors and nurses per square metre than in the ED.
But a situation where patients need to be moved to ED corridors is a sure indicator of an unsafe overcrowded environment.
After 35 years working as an emergency department nurse I can say that when this situation of access block leading to ED overcrowding arises, many patients are NOT safe.
Why is overcrowding in the Emergency Department SO unsafe?
There is now overwhelming evidence in the medical literature that overcrowding of our Emergency Departments leads to an increased death rate (mortality) and increased poor outcomes in care (morbidity) for all patients effected.
Specifically, overcrowding threatens a decreased access to quality healthcare.
Increased workloads amongst ED staff leads to delays in patients receiving analgesia, and delays in patients receiving antibiotics.
It leads to increased waiting times, meaning it will take longer to commence care of new patients who are sometimes in need of urgent interventions.
It also leads to increased likelihood of clinical errors (usually errors of omission due to high workloads on individual staff), or of accidents leading to physical injury (slips, falls etc).
Patients who remain in the ED for extended periods of time waiting for an ICU bed have an increased hospital length of stay and higher mortality rates.
Despite the best efforts of the medical staff, if you are placed in an emergency department corridor waiting for a ward bed you will be much more likely to feel you have lost your privacy, your dignity, and are not having your rights as a patient met.
What can I do about this?
Unfortunately, in the short-term there is very little you can do to improve the situation. Try to remember that the staff working in the ED have no control over this problem and are doing their very best to maintain a high level of quality care to ALL patients in the ED.
But there are definitely things you can do to raise awareness of this situation.
Document your experience. For example you can write down the times you were seen by staff, you can record how long you have waited, how you are feeling, and any problems or issues that occur whilst being treated in a corridor. You should also document any positive experiences as well.
Ask a staff member how you can make a written complaint. Most hospitals have a complaints or consumer engagement units that will follow-up on all written complaints and respond back to you. Some units will also have telephone contact numbers for this purpose.
Read your charter of healthcare rights and consider if they were being met during your stay.
You can also write or speak to your local minister to voice your concerns.
When raising your issues with the hospital or with government, tell them what you experienced, how it made you feel, and what you expect to be done about it. Ask them how they specifically plan to respond to ED overcrowding in order to provide safer and more effective care delivery.
ED overcrowding has been a significant problem in our heath system for many years now. And the situation continues to deteriorate.
Unless a public awareness of this problem brings sustained pressure to drive changes, it is likely that patients will continue to be moved to corridors in our ED’s with all the risks and frustrations that result.
- Emergency department care 2017–18: Australian hospital statistics.Australian Institute of Health and Welfare.
- Access block and emergency department overcrowdingCritical Care (2011).
- Emergency department crowding: towards an agenda for evidence-based intervention. BMJ (2012)
Ian Miller is a retired nurse with 35 years experience working in a major Australian emergency department.