Crowding in Paediatric Emergency Department, A Review of the Literature and a Simulation-Based Case Study

Emergency Department (ED) overcrowding, is a common problem across the globe. The imbalance between supply and demand for emergency service is becoming bigger and bigger, especially in countries with sluggish economies where healthcare is based on the principle of universal coverage (like Italy). Given its relevance, ED overcrowding has been the object of a sizeable number of studies examining the causes, effects, and solutions to ED overcrowding. Overcrowding in Paediatric EDs (PEDs) however, is still an under-investigated phenomenon. PEDs differ from general EDs in a number of ways: (i) the overall acuity of patients and (consequently) the number of admissions are lower (8 to 10% in PEDs vs 15 to 20% in adult EDs [4]); (ii) arrivals peak in the afternoon, when parents return home from work and in the weekends, when availability of paediatricians is limited; (iii) arrivals present a seasonal variation with peaks in winter months, due to influenza and respiratory illnesses and in the summer months (when kids play outdoor) due to fractures and lacerations; (iv) nurses and physician need to interact with both patients and their parents. In this study, we have performed a comprehensive and systematic review of the literature on PED. Starting form a sample of 3607 papers, following a structured classification procedure we consolidated a final sample of 47 papers analysing the causes and proposing organisational solutions to address overcrowding problem in PED. These papers were read and thoroughly coded. The analysis led to the identification of 16 types of causes of overcrowding, 10 different types of organisational solution to reduce or prevent it, as well as to the identification of the most important performance indicators used in the literature to assess PED performances.