Study identifies specialties most affected by ED access block

Patients with cardiovascular and respiratory illnesses are the most likely to face extended ED waiting times for an inpatient bed, an ‘access block’ study from NSW has shown.

Analysis of almost 27,000 cases where patients spent more than 24 hours in an emergency department  found that older patients and those with cardiorespiratory diagnoses and mental health conditions made up the largest numbers of patients facing prolonged periods waiting for an inpatient bed.

The study researchers, from the University of NSW,  said their findings also showed that patients subject to access block faced a disproportionately higher risk of mortality, especially oncology and haematology patients.

Their analysis was based on state-wide data for 26,854 eligible cases identified as having an ED stay of at least 24 hours.

The most common diagnosis groups were cardiology (13.6%), psychiatry (13.21%), respiratory (12.52%) and non-specialty medicine (12.49%).

The 30-day all-cause mortality rates in access block patients were highest for those aged >75 years (Odds Ratio 15.18), oncology (OR 10.45) and haematology patients (OR 2.95)

The analysis showed that most ‘access block’ patients were waiting for a ward bed (81%) but almost 7% were waiting for a critical care bed and 13% were transferred to another acute care facility. Only 15% were classified as triage category 4 or 5 (semi- to non-urgent presentation).

There was also evidence of significantly higher access block for mental health and critical care beds in non-tertiary settings compared to tertiary hospitals.

The study investigators noted that over 30% of access block patients were over 75 years of age and 20% spent more than 36 hours waiting for an in-patient bed.

They said there was “already ample evidence demonstrating the adverse outcomes associated with prolonged ED length of stay,” and the present study highlighted the patient groups most impacted by access block.

“Interventions and models of care to address ED access block need to focus on mental health patients, older patients with cardiorespiratory illness as well as oncology and haematology patients for whom risk of mortality is disproportionately higher,” they concluded.

The results are published in Emergency Medicine Australasia (link here).


Speciality group – Non-tertiary/Tertiary hospital patients in ED >24 hours

Cardiology – 11.28%/14.18%

Endocrinology – 1.02%/1.11%

Gastroenterology – 8.97%/8.32%

Haematology – 0.37%/1.19%

Oncology – 1.41%/1.42%

Neurology – 6.24%/8.63%

Renal – 1.43%/1.96%

Respiratory – 11.3%/12.80%

General medicine – 13.31%/12.31%

Upper GIT surgery – 2.08%/1.76%

Neurosurgery – 1.99%/2.61%

ENT – 1.23%/1.37%

Orthopaedics – 3.35%/3.79%

Urology 0.20%/1.31%

Other surgery – 4.09%/4.32%

Drug and alcohol – 1.99%/2.50%

Psychiatry – 19.6%/11.51%

Other medical – 9.43%/8.64%

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