Overcrowding in emergency linked with increased mortality: PGIMER study
The overflow of patients in the paediatrics emergency department (ED) of the Post Graduate Institute of Medical Education and Research (PGIMER) is linked with increased mortality as well as the high frequency of care discontinuation, a study has noted.
A prospective observational study was conducted in the 22-bed emergency between February and December 2019, and has appeared online in the Indian Paediatrics Journal, ahead of its print edition, in February.
The data correlated significant overcrowding in the emergency, as indicated by a high number of non-urgent visits, higher bed occupancy rate, and prolonged stay. The overcrowding correlated with increased frequency of care discontinuation and death on any given day.
“Doubling or trebling of patients on a single bed is practised if the number of patients exceeds the available bed capacity. The nurse-patient and doctor-patient ratios vary from 1:5 to 1:12 for the red area (critical patients), and 1:8 to 1:30 for the yellow area (non-critical ill patients) as there is no provision for surge staffing which compromises the quality of care,” the study states.
The causes of ED overcrowding are divided into input, throughput and output factors.
Input factors include causes that increase patient inflow, for instance, lack of access to primary and increased number of referrals from other sectors of health care. Throughput factors pertain to lack of space, understaffing, and inadequately trained healthcare providers. Non-availability of inpatient beds and delayed transfer out from ED constitute the output factors.
A sizable burden (53%) of the visits was contributed by children with low acuity illness, which, the study suggests, could have been otherwise managed effectively in outpatient settings.
The proposed solutions to curtail input include strengthening of primary and secondary healthcare through capacity building and telemedicine services, establishing an organised referral network, and protecting health workers through proper laws. Trained medical or nursing staff-conducted telephone triage systems were shown to decrease the number of self-referred paediatric emergency attendees.