Access Block: A Comparison Between 2008 And 2010

摘要

Purpose:Access block is a situation where patients can’t access an inpatient bed from emergency department within a reasonable timeframe. Since the recognition of access block in 2008, Emergency Department of Hospital Melaka had adopted open ward system, discharge lounge and assigning nurse bed manager to combat the problem. This study aims to review the phenomenon and establish the effectiveness of approaches taken.Methods:The time when admission for a patient was planned and when he/she was admitted to ward were noted daily by staff nurse in charge in the census book. The data was then compound to be monthly census of the department. Comparative analyses were performed with data from monthly census of years 2008 and 2010 in order to study the waiting hours for admission and access block of emergency department.Results:Despite of the increase in mean total admission (mean difference = 909.97, 95% CI 407.41-1412.53, p-value 0.001), the percentage of patients gain direct admission in 2010 was more than 2008 (71% in 2008 and 75% in 2010). The waiting time for inpatient beds in emergency department had been improved where most of the lodgers were admitted within 2 hours in 2010 (61%). In 2008 only 29% of them admitted within 2hours. Majority of lodgers in 2008 admitted to the wards within 2 to 6 hours (42%).Conclusion:The three measures taken here proved to improve access block in emergency department. Introduction Malacca General Hospital (Malay: Hospital Besar Melaka) is a government-funded public hospital situated in the state of Malacca, Malaysia. As a tertiary and specialist hospital, it serves as a referral centre for patients from primary and secondary health centres in the state as well as the northern part of Johor and the Tampin district of Negeri Sembilan. As a result, the hospital is generally busy with an ever increasing workload. On occasion bed occupancy rates in some wards exceed 100%.According to administrative data collected in Emergency Department Hospital Melaka, the number of admitted patients awaiting inpatient beds in the department had doubled from 2007- 2008. Some factors had been recognised through local experience. For example, bed shortage, ambulance availability for transferring patients and discharged patients occupying inpatient beds while waiting for family member to bring them home. In view of that, the department had implemented measures to combat the increment of access block since 2008. The main measures taken are open ward system, assigning nurse bed manager and discharge lounge.The primary end points of the study are to review the phenomenon of access block in emergency department Hospital Melaka and the effectiveness of the measurements taken to overcome access block. Methodology The reference population for this study was all the patients who were admitted from the Emergency Department Hospital Melaka throughout the year of 2008 and 2010. All patients who fulfil the inclusion and exclusion criteria during the study period were included in this study.We included all the patients who were admitted from the department of Emergency and Trauma except psychiatric patients, paediatric patients, patients admitted to Intensive care unit or Coronary care unit as well as patients who decided for at own risk discharge. According to Hospital policy, cases of psychiatry, paediatrics, intensive care unit and coronary care unit had to be admitted to their respective wards only. Thus, they were excluded from the study.This study was carried out by retrospective analysis on monthly census of the Emergency department Hospital Melaka for the calendar years of 2008 and 2010. The time when admission for a patient was planned and when he/she was admitted to ward were noted daily by staff nurse in charge in the census book. The data was then compounded to be monthly census of the department. From the monthly census, patients who requested to be discharged at own risk in emergency department were excluded from the