Crowding is a challenge that is spreading as pressure on the healthcare system increases. In short, the term can be defined as a situation where a department’s resources — such as staff, beds, and equipment — cannot meet the current demand. In a hospital context, emergency departments are particularly vulnerable to this imbalance, as they often serve as the main entry point to hospitals and frequently experience significant and unpredictable fluctuations in patient inflow.
However, the issue of crowding is not merely a matter of being busy. It represents a state in which delays and overcrowding lead to a significant reduction in the quality and efficiency of care. The term refers to situations where the number of patients exceeds the capacity to treat them safely within a reasonable timeframe.
This is a complex problem with potentially serious — and in extreme cases, fatal — consequences for both patients and staff.
What causes crowding?
To understand how crowding arises and affects the healthcare system, we take a closer look at the so-called input/throughput/output model. This model breaks down the patient journey through the system into three stages, which can be briefly explained as follows:
Input: Patients arrive at the emergency department, either by ambulance, via their general practitioner, or through out-of-hours medical services. A high influx of patients — such as during flu seasons or other peak periods — can lead to input exceeding the department's capacity.
Throughput - this stage involves the diagnostic and treatment processes within the department. Long wait times for test results or insufficient staffing can slow patient flow and worsen congestion.
Output - in this phase, patients are either discharged or transferred to other departments. Crowding often occurs when output is blocked or delayed, e.g. due to a lack of available beds in subsequent treatment units.
Consequences and risks related to crowding
The consequences of crowding can be severe, affecting both patients and healthcare staff. For patients, delays in treatment can lead to worsened health outcomes, an increased risk of complications, and, in some cases, higher mortality rates. Acute conditions, such as severe infections (e.g., sepsis), demand prompt intervention, and even brief delays can have fatal consequences. Additionally, a high-pressure work environment raises the risk of errors, for instance, when there is insufficient time to double-check diagnoses and treatments.
For healthcare staff, crowding can result in poor communication, reduced efficiency, diminished job satisfaction, sick leave, burnout, and stress, all of which may ultimately contribute to high staff turnover.
At a systemic level, crowding can lead to inefficient resource utilization, higher costs, and decreased patient satisfaction.
Busyness vs. crowding
It is important to distinguish between busyness and crowding, as these two concepts are not synonymous. Busyness is a common aspect of work in settings like emergency departments, where staff are accustomed to handling a high influx of patients. Crowding, on the other hand, occurs when the system can no longer manage the workload, leading to increased wait times and reduced quality of care. While busyness can be seen as a temporary condition, crowding is a sign of a more structural imbalance.
Can Praemostro's system make a difference?
Crowding is one of the challenges that Praemostro has aimed to address with the development of its forecasting system — and it works!
By analyzing historical data, monitoring real-time information, and feeding the algorithm with a wide range of additional data, our system can predict patient inflow with high accuracy, revealing peak times, for example. We cannot change the input, but we can provide insight and an overview, so we know with high precision what the future holds, and in turn, influence throughput and output.
