Exit block in emergency departments: a rapid evidence review

@article{Mason2016ExitBI,
  title={Exit block in emergency departments: a rapid evidence review},
  author={Suzanne M Mason and Emma Knowles and Adrian A Boyle},
  journal={Emergency Medicine Journal},
  year={2016},
  volume={34},
  pages={46 - 51}
}
Background Exit block (or access block) occurs when ‘patients in the ED requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame. [] Key Method Methods A computerised literature search was conducted of English language empirical evidence published between 2008 and 2014 using a combination of terms relating to exit block in ED. Results 233 references were identified following the computerised search.
Hospital Access Block: A Scoping Review.
Factors associated with exit block and impact on the emergency department
TLDR
Some of the factors identified may well be symptomatic of exit block rather than causal, while other factors may be acting as proxies for differences in casemix, social deprivation or ability to access alternative urgent care services.
Emergency department waiting room nurses in practice: An observational study
TLDR
Therapeutic engagement allowed waiting room nurses to reassure and calm patients and families, and deliver holistic, patient-centred care in emergency department waiting rooms.
Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa
Models Predicting Hospital Admission of Adult Patients Utilizing Prehospital Data: Systematic Review Using PROBAST and CHARMS.
TLDR
It is found that select prehospital patient data contribute to the identification of patients requiring hospital admission, and models that utilize biomarker predictors offer additional advantages.
Emergency Services Efficiency at a Tertiary Care Hospital
TLDR
This study showed that almost half of the patients received treatment within four minutes while few of the Patients have to wait for upto twenty five  minutes to get healthcare, which is quite a long time as for as emergency healthcare services is concerned.
Association between long boarding time in the emergency department and hospital mortality: a single-center propensity score-based analysis
TLDR
In this single-center propensity score-based cohort analysis, patients experiencing an ED boarding time longer than 4 h before being transferred to an in-patient bed were at increased risk of hospital death.
Models Predicting Hospital Admission of Adult Patients Utilizing Prehospital Data: Systematic Review Using PROBAST and CHARMS (Preprint)
TLDR
It is found that select prehospital patient data contribute to the identification of patients requiring hospital admission, and models that utilize biomarker predictors offer additional advantages.
Interprofessional barriers in patient flow management: an interview study of the views of emergency department staff involved in patient admissions
TLDR
This study is the first, to the knowledge, to consider the role of interprofessional barriers, defined as suboptimal ways of working, as perceived by ED staff in patient flow management, and holds promise for hospitals beyond the National Health Service in England.
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References

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TLDR
Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS.
Efficacy of a holding unit to reduce access block and attendance pressure in the emergency department
TLDR
The opening of an HU has led to an improvement in the access block, the inability of patients in the emergency department (ED) to access hospital beds, and some medical management indicators is presented.
Entry overload, emergency department overcrowding, and ambulance bypass
TLDR
Unless something is done in the near future, the general public may no longer be able to rely on EDs for quality and timely emergency care and a “whole of system” approach is necessary.
Access block and overcrowding in emergency departments: an empirical analysis
TLDR
Overall an increase in hospital resources, as measured by the number of nurses, doctors and physical beds, is associated with a significant reduction in patient care time in the ED.
Early discharge and its effect on ED length of stay and access block
TLDR
The analysis reveals that, on days when the discharge peak lags the peak in inpatient admissions, hospitals of all sizes exhibit increased levels of occupancy, inpatient and ED length of stay, and access block.
The Referral And Complete Evaluation Time Study
TLDR
The overwhelming reason for prolonged waits and overcrowding in Irish EDs is not the duplication of work inherent in the referral process but it is because of a lack of acute hospital capacity.
Estimating the intensity of ward admission and its effect on emergency department access block
TLDR
It is suggested that improving admission practice during off-peak hours may have most impact on reducing the number of ED access blocks, and the variation in the daily time-varying admission intensities is explored.
Impact of hospital-wide process redesign on clinical outcomes: a comparative study of internally versus externally led intervention
TLDR
Internally led compared with externally led redesign led to superior and sustained improvements in ED access block as a result of major structural reforms that were driven by committed clinicians and managers and cut across departmental boundaries.
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