"A bed, a bed, my kingdom for a hospital bed" An investigation of access block in hospital emergency departments
EMBARGOED UNTIL 12 NOON SUNDAY 3 NOVEMBER 2002
A study in the latest edition of the Medical Journal of Australia shows that patients who spend longer in emergency departments waiting for a hospital bed to become available usually have a longer stay in hospital.
Author of the study, Dr Drew B Richardson, Director of the Emergency Department at the Canberra Hospital, believes that 'access block' - where patients requiring emergency hospital admission spend an unreasonable amount of time in an emergency department because they are unable to gain access to appropriate hospital inpatient beds - has a direct effect on patient outcomes outside the emergency department.
"If the effect of access block on a patients' length of stay is reproduced in other settings, there are major implications for hospital management," Dr Drew says.
Dr Richardson set out to investigate the relationship between access block in the emergency department and inpatient length of stay in the hospital. He retrospectively studied all admissions through the Canberra Hospital emergency department during 1999.
He then measured the total time that patients were in the emergency department against their total length of stay, calculated in days from emergency department departure to hospital discharge.
Of the 11,906 admissions looked at, 919 (7.7 per cent) experienced access block.
The average length of stay for access block patients was 4.9 days, as compared to 4.1 days for other patients. This translates to more than 700 bed-days per year being used by patients affected by access block - a significant figure to be considered by any hospital administration.
Significantly, a strong relationship was found between longer length of stay and arrival of access block patients on the inpatient ward outside office hours.
Dr Richardson says the access block effect may have ramifications for funding models as well as major implications for management of hospital patient flow.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Associate Professor Drew B Richardson
Phone: 02 6244 2418
E-mail: drew.richardson@act.gov.au
Judith Tokley, AMA Public Affairs, 0408 824 306