Ayden Jacob, MD, MSc

The Crucial Link Between Emergency Department Flow and Overcrowding

The emergency department (ED) serves as the frontline of acute medical care, tasked with promptly assessing and treating patients with a wide range of illnesses and injuries. However, when the ED becomes overcrowded, the ability to deliver timely and effective care is compromised, leading to significant clinical repercussions for health systems. A good portion of inpatient hospital admissions are funneled through the ED.  Consequently, the logistics and workflow efficiencies of the ED directly impact downstream clinical care. Beyond the influence on direct patient care, studies demonstrate that delays in the ED have negative economic and financial repercussions for the healthcare system as well.

Several factors contribute to delays and overcrowding in the emergency department, such as: 

  • The increasing demand for emergency services, driven by factors such as population growth, aging demographics and limited access to primary care services. 
  • Wait times for patients to visit their PCP are growing year over year, and many patients opt to visit their local emergency room in lieu of waiting long durations for outpatient visits with their primary care doctor. 
  • Inefficiencies within the healthcare system, such as inadequate staffing levels, insufficient inpatient bed capacity and patient transfer delays.

From an economic perspective, ED delays have far-reaching financial implications for healthcare systems, patients and society as a whole. Prolonged wait times in the ED may correlate with increased healthcare costs by necessitating additional diagnostic or therapeutic interventions in light of progressive disease evolution. Patients who experience delays in the ED may require more extensive medical interventions or face complications that result in longer hospital stays, further driving up healthcare expenditures. In both a clinical and economic vein, overcrowding in the ED contributes to ambulance diversions, where ambulances are redirected to other facilities due to capacity constraints. This not only results in lost revenue for the hospital but increases transportation costs and delays access to care for patients in need of emergency medical services.

The Impact of AI and Radiology in the ED 

Delays in radiologic imaging results have been identified as a significant contributor to increased wait times and overcrowding in the emergency department, impacting patient flow and potentially even clinical outcomes. Radiology turnaround times may directly impact our ability to treat and triage patients, thereby improving overall efficiencies in the ED.  A study by Cournane et al. analyzed the impact of radiology processing times and patient outcomes. Their study demonstrated that delays related to imaging time correlated with longer hospital lengths of stays. Moreover, increased delays in CT and MRI corresponded with increased hospital costs. Timely access to radiology reports is essential for expediting diagnostic evaluations, guiding treatment decisions, and facilitating patient disposition in the ED.

Addressing the issue of radiology turnaround times requires a multifaceted approach, involving collaboration between ED physicians, radiologists, and hospital administrators. Implementing technology-driven solutions, optimizing workflow processes, and fostering effective communication channels can help minimize delays in radiologic imaging results and improve overall ED throughput. By prioritizing timely access to diagnostic information, healthcare institutions can enhance patient care delivery, mitigate the burden of ED overcrowding, and ultimately improve clinical outcomes for patients presenting to the emergency department. More specifically, digital workflow automation tools can inform the radiologist that a given patient’s radiologic exam is urgent, thereby prompting the patient to be pushed to the top of the reading list.

Certainly, a mutual trust must exist between the reading radiologist and ED physician such that when an urgent request is sent. Providing ED physicians with the ability to request radiology reads quicker and obtain the results back in real-time, enables them to make quicker clinical decisions regarding patient disposition. Furthermore, enabling ED physicians with  in-app care coordination tools allows them to communicate with on-call, available radiologists and other involved specialists as to the indications of a given radiology report, offering a quick and more seamless structure to providing expedient and high quality patient care.

Overcrowding in the emergency department has profound clinical and economic implications that impact patient outcomes, healthcare costs, and the overall efficiency of the healthcare system. By implementing targeted interventions to address the underlying causes of ED delays and overcrowding, healthcare organizations can improve patient care, enhance resource utilization, and mitigate the financial burden associated with emergency department overcrowding.

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Ayden Jacob, MD, MSc