Emergency section and overcrowding in a university hospital of Karachi, Pakistan.
OBJECTIVE
To quantify the extent of Emergency Section overcrowding at a tertiary care hospital and to identify possible solutions.


METHODS
This was a retrospective chart review of all the patients presented to the Aga Khan University Hospital's (AKUH) Emergency Section (ES). The ES information system has an automatic patient log and generates daily report for patients who stay longer than 6 hours. The charts of all patients who stayed longer than 6 hours were reviewed.


RESULTS
Among 9630 patients, 1999 (20.8%) were held in the ES for more than 6 hours. Of those 134 (6.7%) were discharged from the ES, while 1535 (76.8) were admitted to the hospital. About two-third of all delays were due to unavailability of bed, followed by financial constraints, involvement of multiple specialty, and because the admitting residents wanted to investigate the patients more thoroughly.


CONCLUSIONS
Significant overcrowding exists in Emergency Section of the hospital. Four solutions were proposed: (1) early discharges of in-patients, (2) creation of a holding unit, (3) flexible ward assignment, (4) active inter-facility transfer. These efforts will lead to an optimal care in the Emergency Section in rising patient demand.
Section of Emergency Medicine, The Aga Khan University Hospital, Karachi.
R
R
Rehmani
D001509:Bed Occupancy; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D010154:Pakistan; D012189:Retrospective Studies; D014600:Utilization Review