Access block and overcrowding at the emergency department at Tupua Tamasese Meaole Hospital in Samoa

Abstract
Background Access block and overcrowding are known to adversely impact on patient outcomes, service delivery,
and patient experiences within emergency departments (ED) worldwide. There are no studies on access block or
overcrowding from the Pacifc Islands. The aim of the present study is to provide preliminary data on access block and
overcrowding in the ED of the national tertiary hospital of Samoa.
Methods Mixed methods study design. Data collection was performed in March 2020. The quantitative strand calcu‑
lated (1) the point prevalence of patients impacted by access block in the ED, and (2) the ED bed occupancy rate to
assess for overcrowding. The qualitative strand used thematic analysis of two focus group interviews exploring access
block and overcrowding with ED medical and nursing staf members.
Results On the day of data collection, a total of 60 patients presented through the ED triage system. Of the 20
patients who were admitted into ED, 80% were triaged as ‘see without delay’ (CAT1), ‘emergency’ (CAT2) or ‘urgent’
(CAT3). For patients requiring admission to hospital wards, 100% waited 4+h in ED, and 100% waited 8+h, suggest‑
ing the presence of access block. Overcrowding in the ED setting was also evident, with an ED bed occupancy rate
of 0.95, and an adjusted bed occupancy rate of 1.43. The major themes emerging from the ED staf focus groups and
individual in-depth interviews were (1) the adverse impacts of access block and overcrowding, i.e., violence towards
ED staf members, (2) the preventable contributing factors, i.e., lack of physical beds in the ED, and (3) practical recom‑
mendations to improve patient fow through the ED, i.e., improved collaboration between ED, outpatient services,
and the hospital wards.
Conclusions Preliminary evidence suggested the presence of access block and overcrowding in the ED of the
national tertiary hospital of Samoa. ED staf interviews provided insight into the ED frontline challenges and ofered
practical recommendations for ED health service improvement.