ACEM defines access block as “the situation where patients who have been admitted and need a hospital bed are delayed from leaving the Emergency Department (ED) because of lack of inpatient bed capacity.”
An accepted measure of access block in Australasia is an admitted patient who spends longer than eight hours in the ED from their time of arrival.
Key facts about access block
- It occurs when there are not enough inpatient beds in the hospital for patients to move to after treatment in the emergency departments (ED)
- The issue is worsening due to increasing pressure on the Australian and Aotearoa New Zealand health care systems
- It can be addressed through multiple factors lying outside the ED
- Is not related to general practice (GP) type cases, such as colds filling the ED.
- Some patients, such as people who present to the ED with a mental health issue, appear to be at greater risk of experiencing access block.
The impacts of access block
Access block is the principal factor contributing to ED overcrowding, which has repeatedly been shown to result in poorer patient health outcomes, including:
- Longer hospital stays
- Increased errors in care
- An increased likelihood of dying while in hospital.
Access block can also contribute to ambulance ramping which is also associated with poorer patient outcomes. Ambulance ramping refers to the time ambulances are located at a hospital's ED while ambulance officers or paramedics care for their patient until they can be cared for by ED staff.
In the most recent ACEM Access Block Point Prevalence Survey, caring for patients waiting for inpatient beds accounted for approximately one-third of ED workload in Australian hospitals.
Are you struggling to cope with the demands of Access Block in your ED? If you're a Trainee, take a look at the My Wellbeing page and for FACEMs, take a look at your Wellbeing page here.
ACEM is tackling the problem
We lead efforts to address access block that include:
- Publishing research, including regular snapshot surveys to measure access block in Australian EDs
- Producing position statements, policies and papers
- Lobbying and working with authorities to develop solutions
- Addressing misconceptions in the media, attributing access block to an excess of ‘GP-type’ patients and the ‘quick fix’ solutions put forward by health services that are inadequate.
The way forward
Access block is an urgent issue, continuing to worsen due to increased pressure on the health system. In Australia and Aotearoa New Zealand populations are living longer, with more chronic and complex illnesses, for which there are more available treatment options.
A coordinated approach implemented across the entire health system is required to address the critical access block issue. The approach must aim to increase hospital and alternative care capacity and reduce hospital inpatient bed demand.