Initiatives to reduce overcrowding and access block in Australian emergency departments: a literature review.

Australian emergency departments are experiencing an increasing demand for their services. Patient throughput continues to expand resulting in overcrowding and access block where patients cannot gain entry to appropriate hospital beds. This is despite both state and federal governments implementing numerous schemes to address the complex causes of stress on emergency departments. This paper explores the current literature and highlights the key strategies adopted by different emergency departments to reduce delays and streamline patient flow, including: waiting room nurses; streaming; rapid assessment teams; short stay units and care coordination programmes. Many of these initiatives have proven successful at reducing the number of people re-presenting to the emergency department, addressing time delays and improving the management of existing resources and patient flow. More recent changes include increasing the scope of practice and workload for triage nurses. With the recent introduction of the National Emergency Access Target, which requires that most patients presenting to Australian emergency departments are reviewed and transferred or discharged from the department within 4h, traditional roles of nurses in the emergency department are changing and expanding to meet the needs of modern healthcare systems.