Access block is the situation where patients who have been assessed in the emergency department and require admission to 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. Health is a complex ecosystem. When one part of the system is overloaded, demand builds up in other parts of the system. Emergency departments are the most accessible parts of the healthcare system. When hospitals and community services are overloaded or inaccessible, emergency departments become increasingly overloaded, resulting in access block and ambulance ramping.
Access block is a vicious cycle. When a system gets overloaded it becomes less efficient. Addressing this requires a whole of system approach.
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 problems attributable to an excess of lower acuity care, or "GP-type" patients in the emergency department.
ACEM does not endorse the term ‘GP-type’ patients. This term – often used in reports – has never been adequately defined, and downplays the important role of general practitioners, emergency physicians, patients and carers regarding decision making about how and when to seek emergency care.
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 acuity 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 that people who present to EDs with mental health issues 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.
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).
ACEM Policy Team
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ACEM Media Team
Melissa Howard, Manager - Media Relations
+61 427 621 857