title: Strategies and solutions to alleviate access block and overcrowding in emergency departments.
abstract: OBJECTIVE
  Access block refers to the delay caused for patients in gaining access to in-patient beds after being admitted. It is almost always associated with emergency department overcrowding. This study aimed to identify evidence-based strategies that can be followed in emergency departments and hospital settings to alleviate the problem of access block and emergency department overcrowding; and to explore the applicability of these solutions in Hong Kong.
  
  
  METHODS
  A systematic literature review was performed by searching the following databases: CINAHL, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE (OVID), NHS Evidence, Scopus, and PubMed.
  
  
  METHODS
  The search terms used were "emergency department, access block, overcrowding". The inclusion criteria were full-text articles, studies, economic evaluations, reviews, editorials, and commentaries. The exclusion criteria were studies not based in the emergency departments or hospitals, and abstracts.
  
  
  METHODS
  Abstracts of identified papers were screened, and papers were selected if they contained facts, data, or scientific evidence related to interventions that aimed at improving outcome measures for emergency department overcrowding and/or access block. Papers identified were used to locate further references.
  
  
  RESULTS
  All relevant scientific studies were evaluated for strengths and weaknesses using appraisal tools developed by the Critical Appraisal Skills Programme. We identified solutions broadly classified into the following categories: (1) strategies addressing emergency department overcrowding: co-locating primary care within the emergency department, and fast-track and emergency nurse practitioners; and (2) strategies addressing access block: holding units, early discharge and patient flow, and political action--management and resource priority.
  
  
  CONCLUSIONS
  Several evidence-based approaches have been identified from the literature and effective strategies to overcome the problem of access block and overcrowding of emergency departments may be formulated.
authors.affiliation: Emergency Department, Prince of Wales Hospital; Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Stewart S W
authors.initials: SS
authors.lastname: Chan
authors.affiliation: Emergency Department, Prince of Wales Hospital; Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: N K
authors.initials: NK
authors.lastname: Cheung
authors.affiliation: Emergency Department, Prince of Wales Hospital; Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.affiliation: Emergency Department, Prince of Wales Hospital; Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
mesh_terms: D001509:Bed Occupancy; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006723:Hong Kong; D006760:Hospitalization; D006801:Humans; D009722:Nurse Practitioners; D011320:Primary Health Care / Q000458:organization & administration
keywords: Crowding; Emergency service, hospital/utilization