Annales françaises de médecine d'urgence

, Volume 4, Issue 2, pp 96–105 | Cite as

Surcharge du service des urgences : causes, conséquences et ébauches de solutions

  • P.-G. Claret
  • X. Bobbia
  • P. Richard
  • F. Poher
  • J.-E. de La Coussaye
Mise au Point / Update

Résumé

L’essor de la médecine d’urgence comme spécialité à part entière coïncide avec une augmentation de la fréquentation des services d’urgence, tant en France que dans le reste du monde. Il y a surcharge du service des urgences lorsque les capacités de celui-ci sont dépassées par le nombre de patients en attente d’être vu, d’évaluation, de traitement et de place d’hospitalisation. La surcharge des services d’urgence est associée à de nombreux effets indésirables, dont une augmentation des complications et de la mortalité. Cette surcharge, décrite tant en France que dans d’autres pays, est à l’origine d’une littérature grandissante depuis une dizaine d’années. Il est bien démontré que l’origine de cette surcharge est multifactorielle. Pour y trouver des solutions, il convient d’examiner la surcharge dans la globalité du système de soins à la française. Nous présentons donc une revue de la littérature afin de dégager les causes, les conséquences de la surcharge, mais aussi d’en ébaucher les solutions.

Mots clés

Surcharge Service des urgences Hospitalisation Durée de séjour 

Overcrowding in emergency departments: Causes, Consequences and Solutions

Abstract

Abstract The maturation of emergency medicine as a specialty has coincided with increases in emergency department (ED) visit rates, both in France and around the world. Overcrowding in EDs occurs when the physical or staffing capacity of the department is exceeded by the number of patients waiting to be seen, undergoing assessment and treatment or waiting for departure. ED overcrowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. Overcrowding occurs in France and elsewhere in the developed world and has been well documented over the past decade. It became generally recognised that this problem had come about through a combination of factors. To find solutions, we must examine ED crowding in the context of the entire French delivery system. We present a review to understand its causes, its consequences and develop potential solutions.

Keywords

Crowding Emergency service Hospitalization Length of stay 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Schuur JD, Venkatesh AK (2012) The growing role of emergency departments in hospital admissions. N Engl J Med 367:391–3PubMedCrossRefGoogle Scholar
  2. 2.
    Hoot NR, Aronsky D (2008) Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 52:126–36PubMedCrossRefGoogle Scholar
  3. 3.
    Asplin BR, Magid DJ, Rhodes KV, et al (2003) A conceptual model of emergency department crowding. Ann Emerg Med 42:173–80PubMedCrossRefGoogle Scholar
  4. 4.
    Welch SJ, Asplin BR, Stone-Griffith S, et al (2011) Emergency department operational metrics, measures and definitions: results of the Second Performance Measures and Benchmarking Summit. Ann Emerg Med 58:33–40PubMedCrossRefGoogle Scholar
  5. 5.
    Durand AC, Palazzolo S, Tanti-Hardouin N, et al (2012) Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients. BMC Res Notes 5:525PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Afilalo J, Marinovich A, Afilalo M, et al (2004) Nonurgent emergency department patient characteristics and barriers to primary care. Acad Emerg Med 11:1302–10PubMedCrossRefGoogle Scholar
  7. 7.
    Howard MS, Davis BA, Anderson C, et al (2005) Patients’ perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding. J Emerg Nurs 31:429–35PubMedCrossRefGoogle Scholar
  8. 8.
    Ruger JP, Richter CJ, Spitznagel EL, Lewis LM (2004) Analysis of costs, length of stay, and utilization of emergency department services by frequent users: implications for health policy. Acad Emerg Med 11:1311–7PubMedCrossRefGoogle Scholar
  9. 9.
    Dent AW, Phillips GA, Chenhall AJ, McGregor LR (2003) The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg Med 15:322–9CrossRefGoogle Scholar
  10. 10.
    Schull MJ, Mamdani MM, Fang J (2004) Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med 44:61–7PubMedCrossRefGoogle Scholar
  11. 11.
    Kocher KE, Meurer WJ, Desmond JS, Nallamothu BK (2012) Effect of testing and treatment on emergency department length of stay using a national database. Acad Emerg Med 19:525–34PubMedCrossRefGoogle Scholar
  12. 12.
    Soong C, High S, Morgan MW, Ovens H (2013) A novel approach to improving emergency department consultant response times. BMJ Qual Saf 22:299–305PubMedCrossRefGoogle Scholar
  13. 13.
    DREES. Recueil d’indicateurs régionaux: offre de soins et état de santé des populations, SAE 2000 et 2009, et INSEE (http://www.sante.gouv.fr/IMG/pdf/cpom_offre_sanitaire.pdf)
  14. 14.
    Ye L, Zhou G, He X, et al (2012) Prolonged length of stay in the emergency department in high-acuity patients at a Chinese tertiary hospital. Emerg Med Australas 24:634–40PubMedCrossRefGoogle Scholar
  15. 15.
    Hodgins MJ, Moore N, Legere L (2011) Who is sleeping in our beds? Factors predicting the ED boarding of admitted patients for more than 2 hours. J Emerg Nurs 37:225–30PubMedCrossRefGoogle Scholar
  16. 16.
    Kulstad EB, Sikka R, Sweis RT, et al (2010) ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med 28:304–9PubMedCrossRefGoogle Scholar
  17. 17.
    Fayyaz J, Khursheed M, Mir MU, Mehmood A (2013) Missing the boat: odds for the patients who leave ED without being seen. BMC Emerg Med 13:1PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Miro O, Antonio MT, Jimenez S, et al (1999) Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 6:105–7PubMedCrossRefGoogle Scholar
  19. 19.
    Richardson DB (2006) Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 184:213–6PubMedGoogle Scholar
  20. 20.
    Sprivulis PC, Da Silva JA, Jacobs IG, et al (2006) The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 184:208–12PubMedGoogle Scholar
  21. 21.
    Felton BM, Reisdorff EJ, Krone CN, Laskaris GA (2011) Emergency department overcrowding and inpatient boarding: a state wide glimpse in time. Acad Emerg Med 18:1386–91PubMedCrossRefGoogle Scholar
  22. 22.
    Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA (2011) Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 342:d2983PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Singer AJ, Thode HC, Viccellio P, Pines JM (2011) The association between length of emergency department boarding and mortality. Acad Emerg Med 18:1324–9PubMedCrossRefGoogle Scholar
  24. 24.
    White BA, Biddinger PD, Chang Y, et al (2012) Boarding inpatients in the emergency department increases discharged patient length of stay. J Emerg Med 44:230–5PubMedCrossRefGoogle Scholar
  25. 25.
    Bair AE, Song WT, Chen YC, Morris BA (2010) The impact of inpatient boarding on ED efficiency: a discrete-event simulation study. J Med Syst 34:919–29PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Ackroyd-Stolarz S, Read Guernsey J, Mackinnon NJ, Kovacs G (2011) The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: a retrospective cohort study. BMJ Qual Saf 20:564–9PubMedCrossRefGoogle Scholar
  27. 27.
    Forster AJ, Stiell I, Wells G, et al (2003) The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 10:127–33PubMedCrossRefGoogle Scholar
  28. 28.
    Zhou JC, Pan KH, Zhou DY, et al (2012) High hospital occupancy is associated with increased risk for patients boarding in the emergency department. Am J Med 125:416PubMedCrossRefGoogle Scholar
  29. 29.
    Bucheli B, Martina B (2004) Reduced length of stay in medical emergency department patients: a prospective controlled study on emergency physician staffing. Eur J Emerg Med 11:29–34PubMedCrossRefGoogle Scholar
  30. 30.
    Paul JA, Lin L (2012) Models for improving patient throughput and waiting at hospital emergency departments. J Emerg Med 43:1119–26PubMedCrossRefGoogle Scholar
  31. 31.
    Harris A, Sharma A (2010) Access block and overcrowding in emergency departments: an empirical analysis. Emerg Med J 27:508–11PubMedCrossRefGoogle Scholar
  32. 32.
    Wai AK, Chor CM, Lee AT, et al (2009) Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study. Int J Emerg Med 2:141–8PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Schull MJ, Kiss A, Szalai JP (2007) The effect of low-complexity patients on emergency department waiting times. Ann Emerg Med 49:257–64PubMedCrossRefGoogle Scholar
  34. 34.
    Kellermann AL, Weinick RM (2012) Emergency departments, Medicaid costs, and access to primary care — understanding the link. N Engl J Med, 366:2141–3PubMedCrossRefGoogle Scholar
  35. 35.
    Bullard MJ, Villa-Roel C, Guo X, et al (2012) The role of a rapid assessment zone/pod on reducing overcrowding in emergency departments: a systematic review. Emerg Med J 29:372–8PubMedCrossRefGoogle Scholar
  36. 36.
    Jang JY, Shin SD, Lee EJ, et al (2013) Use of a comprehensive metabolic panel point-of-care test to reduce length of stay in the emergency department: a randomized controlled trial. Ann Emerg Med 61:145–51PubMedCrossRefGoogle Scholar
  37. 37.
    Berthelot JM, Le Goff B, Maugars Y (2011) The hawthorne effect: stronger than the placebo effect? Joint Bone Spine 78:335–6PubMedCrossRefGoogle Scholar
  38. 38.
    Jones P, Harper A, Wells S, et al (2012) Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project. Emerg Med Australas 24:303–12PubMedCrossRefGoogle Scholar
  39. 39.
    Beniuk K, Boyle AA, Clarkson PJ (2012) Emergency department crowding: prioritising quantified crowding measures using a Delphi study. Emerg Med J 29:868–71PubMedCrossRefGoogle Scholar
  40. 40.
    Howell E, Bessman E, Kravet S, et al (2008) Active bed management by hospitalists and emergency department throughput. Ann Intern Med 149:804–11PubMedCrossRefGoogle Scholar
  41. 41.
    Khanna S, Boyle J, Good N, Lind J (2012) Unravelling relationships: hospital occupancy levels, discharge timing and emergency department access block. Emerg Med Australas 24:510–7PubMedCrossRefGoogle Scholar
  42. 42.
    Powell ES, Khare RK, Venkatesh AK, et al (2012) The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med 42:186–96PubMedCrossRefGoogle Scholar
  43. 43.
    Stowell A, Claret PG, Sebbane M, et al (2013) Hospital out-lying through lack of beds and its impact on care and patient outcome. Scand J Trauma Resusc Emerg Med 21:17PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    McNaughton C, Self WH, Jones ID, et al (2012) ED crowding and the use of nontraditional beds. Am J Emerg Med 30:1474–80PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Richards JR, Ozery G, Notash M, et al (2011) Patients prefer boarding in inpatient hallways: correlation with the national emergency department overcrowding score. Emerg Med Int 2011:840459Google Scholar

Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2014

Authors and Affiliations

  • P.-G. Claret
    • 1
  • X. Bobbia
    • 1
  • P. Richard
    • 1
  • F. Poher
    • 2
  • J.-E. de La Coussaye
    • 3
  1. 1.Pôle anesthésie-réanimation-douleur-urgencesCHU de NîmesNîmes cedex 09France
  2. 2.Directeur de la clientèleCHU de NîmesNîmes cedex 09France
  3. 3.Pôle anesthésie-réanimation-douleur-urgencesuniversité Montpellier-Nîmes, CHU de NîmesNîmes cedex 09France

Personalised recommendations