Strategies to mitigate emergency department crowding and its impact on cardiovascular patients

Christopher W Baugh; Yonathan Freund; Philippe Gabriel Steg; Richard Body; David J Maron; Maame Yaa A B Yiadom

doi:10.1093/ehjacc/zuad049

Strategies to mitigate emergency department crowding and its impact on cardiovascular patients

Eur Heart J Acute Cardiovasc Care. 2023 Sep 25;12(9):633-643. doi: 10.1093/ehjacc/zuad049.

Authors

Christopher W Baugh¹, Yonathan Freund², Philippe Gabriel Steg³, Richard Body^{4

5}, David J Maron⁶, Maame Yaa A B Yiadom⁷

Affiliations

¹ Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Neville House 2nd Floor, Boston, MA 02115, USA.
² Emergency Department Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
³ Department of Cardiology, Université Paris-Cité, Institut Universitaire de France, FACT, French Alliance for Cardiovascular Trials, INSERM-1148, and Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.
⁴ Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
⁵ Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
⁶ Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
⁷ Department of Emergency Medicine, Stanford University, Palo Alto, CA, USA.

PMID: 37163667
DOI: 10.1093/ehjacc/zuad049

Abstract

Emergency department (ED) crowding is a worsening global problem caused by hospital capacity and other health system challenges. While patients across a broad spectrum of illnesses may be affected by crowding in the ED, patients with cardiovascular emergencies-such as acute coronary syndrome, malignant arrhythmias, pulmonary embolism, acute aortic syndrome, and cardiac tamponade-are particularly vulnerable. Because of crowding, patients with dangerous and time-sensitive conditions may either avoid the ED due to anticipation of extended waits, leave before their treatment is completed, or experience delays in receiving care. In this educational paper, we present the underlying causes of crowding and its impact on common cardiovascular emergencies using the input-throughput-output process framework for patient flow. In addition, we review current solutions and potential innovations to mitigate the negative effect of ED crowding on patient outcomes.

Keywords: Accident and emergency; Cardiovascular emergency; Crowding; Emergency department; Emergency medical services; Health policy.

Publication types

Review

MeSH terms

Crowding
Emergencies*
Emergency Service, Hospital*
Humans