Causes and Solutions For Emergency Department Overcrowding. A Qualitative Study of Healthcare Staff

Abstract

Background: Emergency departments (EDs) are the units where the diagnosis and treatment of acute cases requiring immediate intervention and the ED environment could be chaotic and risky for staff and patients. However, ED overcrowding is a major problem globally and lead to many negative consequences such as long waiting time, reduced satisfaction of patients and healthcare staff, delays in the treatment of patients who most require urgent care, decreased quality of the health care provided, and increased health care costs. The aim of this study is to determine why patients prefer to use the ED, to identify current problems of ED services and to develop solutions to alleviate ED overcrowding and associated problems from the perspectives of ED healthcare staff. Methods: This study utilised a qualitative approach. The participants were ED consultants, ED doctors and ED nurses. Semi-structured interviews were conducted with 22 participants between 20th December 2021 and 18th February 2022. Those who have at least 1 year of experience in ED settings were included in this study. The settings for this study were Diyarbakir Training and Research Hospital (4 ED nurses, 1 ED consultant, and 2 ED doctors), Mardin Training and Research Hospital (3 ED nurses and 2 ED doctors), Midyat Public Hospital (1 ED consultant, 1 ED doctor and 3 ED nurse), Kiziltepe Public Hospital (3 ED nurse), and Ceylanpinar Public Hospital (1 ED nurse and 1 ED doctor). Ethical approval was obtained from Mardin Artuklu University Ethics Committee (Date: 14/12/2021, Ref: E-76272411-900-36850). Findings: Twenty-two ED healthcare staff were interviewed; 16 were male and 6 were female. The participants were aged between 21-30 (n=12), 31-40 (n=6) and 41-50 (n=4). ED staff interviews were conducted with 14 ED nurses, 6 ED doctors, and 2 ED consultants, who had at least 1-year of work experience in the ED, without any consideration of their gender or age. Five main themes emerged: Insufficient healthcare system, patient-related problems, ED advantages, consequences of ED overcrowding, and solutions for ED overcrowding. Conclusion: Insufficient healthcare system, ED advantages, and patients’ perceptions about using healthcare services led patients to use ED and subsequently to the ED overcrowding. There is a need for effective solutions to alleviate ED overcrowding. The precautions to limit non-urgent ED visits are not enough. Many factors need to be considered and all of them should be applied together accordingly.