ED overcrowding in Taiwan: Facts and strategies

The objective of this study was to quantity the extent of emergency departm ent (ED) overcrowding in Taiwan and to identify possible solutions, The ED log was reviewed for all patients who presented to the National Taiwan Univ ersity Hospital's ED from January 16, 1996 through February 15, 1996 Charts from patients held longer than 72 hours were reviewed. Among 5,810 patient s, 213 (3.6%) were held in the ED for more than 72 hours (7.1 patients per day). In 149 (70.0%) of them, admission was indicated but delayed (42 becau se more than one subspecialty were involved, 57 because of unavailability o f bed, and 50 because of the disparity in admission priority between the em ergency physicians and house staffs). Eighteen (8.4%) patients did not meet admission criteria (13 could have been treated in outpatient clinics, 3 ne eded placement in nursing homes, 2 because of personal problems). The other s (22%) recovered while waiting. Significant overcrowding exists in EDs in Taiwan. Four solutions are proposed: (1) creation of a holding unit; (2) fl exible ward assignment; (3) pre-established rules for admission priority-se tting; and (4) active interfacility transfer. Only through these efforts ca n EDs in Taiwan guarantee an optimal level of care in the face of a growing patient demand. Copyright (C) 1999 by W.B. Saunders Company.