Nor, Wan Suzanne Wan Mohd
(2017)
The effects of access block in the Emergency Department, Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background:
Emergency Department(ED) is the hospital’s access door to inpatient treatment and
management. Overcrowding and access block had been recognized as the major challenges
in Emergency Department nowadays. Access block, or delays in admission of patients to
hospital inpatient areas from ED, has been linked to increase the length of inpatient
hospital stay, increase comorbidity and mortality as well as being the fundamental problem
leading to ED overcrowding. This study is to determine the effects of access block in the
ED specifically to the length of inpatient hospital stay and correlation with the patient’s
mortality.
Objective:
To study the effects of access block in the Emergency Department, Hospital Universiti
Sains Malaysia, Kubang Kerian.
Methodology:
A retrospective study was conducted in Emergency Department, Hospital Universiti Sains
Malaysia, Kelantan between the period of June 2016 till August 2016 involving all patients
registered at Emergency department. The data were obtained from Emergency Department
registration record. Patient’s folders were reviewed to get further information pertaining to
the study. The relationship between access block with the patient’s length of hospital stay
and mortality were analyzed using comparative analysis and Logistic regression.
Results:
A total of 270 patients were recruited for the study. 104 patients (38.5%) were delayed to
get the inpatient bed within the appropriate time frame which is more than 4 hours from
the decision time of admission. Majority of these group (access block group), (74, 71.1%)
were medical cases in comparison to surgical cases (30, 28.9%). Mean access block time in
medical cases was 9 hours and 18 minutes while in surgical cases was 7 hours and 41
minutes. The mean length of hospital stay (LOS) in access block group was 6.35 days
(95% CI=5.27 to 7.42 days), compared with 5.98 days (95% CI=4.56 to 7.40) in non
access block group. For the mortality, there were 9 death in the access block and 3 in the
non access block (3.6% and 1.2% respectively, P= 0.031).
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