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Exit Block

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The content you’re about to read or listen to is at least two years old, which means evidence and guidelines may have changed since it was originally published. This content item won’t be edited but there will be a newer version published if warranted. Check the new publications and curriculum map for updates

Author: Cliff Mann / Code: CC25 / Published: 12/09/2014

Exit block occurs when patients in the emergency department who require admission to the hospital are unable to be moved to a bed on a ward because of a lack of availability. This can occur at any time following completion of the investigations and treatment required in the emergency department.

The 4 hr target has undoubtedly been effective in reducing the numbers of patients affected and is an easily accessed proxy measure of the scale of the problem. This year the care of more patients has been compromised and the College of Emergency Medicine seeks to highlight the adverse consequences for patients and staff.

Importantly, we aim to explain and describe some of the solutions through the launch of a paired video and the Crowding Guideline issued by the College.

Exit block currently affects over 500,000 patients in the UK each year and accounts for as many as 3000 avoidable deaths. In addition each delayed patient increases the congestion in an emergency department which compromises the care of others, especially those queuing with ambulance crews.

The pernicious nature of exit block is further exacerbated because there is good evidence that patients admitted from over-crowded departments have a substantially increased length of stay which in turn reduces bed availability and compounds the problem!

Paradoxically the emergency department has little control over the constraints that must be overcome to remove exit block and restore flow. It is only through a widespread understanding of all hospital staff that small changes in behaviour, timeliness of decisions and actions can either substantially improve or worsen exit block in our hospitals, that the problem can be ameliorated and overcome.

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