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Lost bed capacity in emergency departments: A descriptive analysis and data visualisation exploration

The Royal Adelaide Hospital recently hit the news with a major bed-block. It was reported to have declared a ‘major incident alert’, requiring the rescheduling of non-urgent elective surgery (The Advertiser, 8 June 2021: ‘Royal Adelaide Hospital declares ‘major incident alert’ as it struggles with patient surge’). Not long before, in May, the Flinders Medical Centre had also been reported to issue an ‘internal disaster’ code, alerting to over-capacity (The Advertiser, 3 May 2021: ‘All SA’s public hospitals were over capacity on Monday, with ‘internal disaster’ recorded at Flinders Medical Centre’). Of course, the issue is not unique to South Australia.

Clinical governance has many moving pieces, one of which is the ability to meet the requisite capacity to provide appropriate care. This capacity is invariably associated with the number of patients coming through emergency departments (EDs). The complexity of our health system calls for novel approaches to longstanding problems, such as presented in this original paper by Associate Professor Paul Middleton et al. Specifically, the paper notes it ‘is essential to conceptualise the ED within the health system as both complex and adaptive recognising that intractable problems such as bed block are the inherent result of non-linear relationships between multiple factors, most of which are external to the ED.’

This recently published study analyses the time spent by patients in an ED bed despite being ready for discharge - identified as ‘ lost bed capacity’ (LBC). On this basis, it was concluded that many patients spend more time in ED than necessary, and as such LBC ‘represents a prime target to reduce overall ED length of stay'. The study concludes that LBC as a parameter may be ‘a useful measure of overall ED function and may be a useful indicator of ED overcrowding.’

Access the article here (abstract only). 

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