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Access block is the situation where emergency department patients who have been admitted and need a hospital bed are delayed from leaving the emergency department for more than eight hours due to a lack of inpatient bed capacity.

What causes access block?

Access block is a whole-of-health-system issue that essentially acts as a negative feedback loop.

Significant delays in emergency department patient flow (due to lack of available hospital beds) leads to delays in the treatment of new patients (as emergency department staff are managing access-blocked patients). This leads to ambulance ramping and longer wait times for newly arrived patients. More patients are therefore likely to leave the ED before receiving the essential treatment they need.

“GP-type” patients are not the problem

Access block – and emergency department overcrowding – are often framed as a problem attributable to an excess of lower urgency care, or "GP-type" patients in the emergency department.
 
However, access block is not contributed to or compounded by "GP-type" patients. In fact, our internal analysis using Australian Institute of Health and Welfare (AIHW) data from 2015-16 to 2018-19 suggests the opposite.
 
Across all Australian jurisdictions, AIHW data shows that when there is an increase of 74,858 lower urgency care patients in the emergency department system, emergency department length of stay for more acute patients needing hospital admission decreases by five hours and 24 minutes.

What are the impacts of access block?

Access block significantly impacts on patients, who are likely to face:

  • delays in assessment and treatment;
  • increased risk of exposure to error;
  • increased length of stay in hospital; and
  • worse health outcomes – including increased inpatient mortality.

Recent research has shown that new patients presenting to an ED have a 10 per cent greater chance of dying within seven days of admission when more than 10 per cent of current patients waiting for admission in that ED are suffering access block.

Across 93 Australian emergency departments in September 2020, an average of 67 per cent of current patients waiting for admission were suffering access block. Our research has shown mental health patients are at greater risk of experiencing access block.

It also impacts emergency department staff

In September 2020, more than two-thirds of patients waiting for hospital admission were access blocked; these patients accounted for 21 per cent of the entire ED staff workload. In 2019, ACEM’s members identified overcrowding and access block as their top workplace stressors.

Get support

If you are an ACEM member or trainee  struggling to cope with the demands of access block in your emergency department, support is available. Please check out our resources.

What does access block cost?

The cost associated with inappropriate emergency department bed occupancy represents a large cost to individual emergency departments and consequently to the overall healthcare system. AIHW data shows that more than 522,500 ED patients were suffering access block in 2018-19. Based on ACEM's internal analysis, this cost the health system AUD$583 million (range of $222-833 million).
 

Contact

ACEM Policy Team
61 (3) 9320 0444
[email protected]

ACEM Media Team
Andrew MacDonald, Manager - Media Relations
+61 3 8679 8813 or +61 498 068 023
[email protected]

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