Tai Ting-Li, Chou San-Fang, Hsieh Chien-Chieh, Sim Shyh-Shyong, Hung Tzu-Yang, Yeh Yin-Chen, Tsai Kuang-Chau
Far Eastern Memorial Hospital Department of Emergency Medicine New Taipei City Taiwan.
Far Eastern Memorial Hospital Department of Medical Research New Taipei City Taiwan.
J Acute Med. 2025 Sep 1;15(3):86-97. doi: 10.6705/j.jacme.202509_15(3).0002.
Emergency department (ED) overcrowding has become a widespread global problem, with multi-factorial causes spanning input, throughput, and output domains. In Taiwan, the unique context of universal health coverage and a severe nursing shortage further complicates the situation. The Lunar New Year holiday period is associated with increased ED demand, yet the extent, causes, and responses to post-holiday overcrowding remain unclear.
We conducted a descriptive observational survey targeting ED directors from all certified emergency care hospitals in Taiwan one week after the 2024 Lunar New Year holiday (February 8 to 14). The questionnaire compared operational status with the same period in previous years, assessing patient volume, bed availability, staffing, perceived causes of overcrowding, and implemented countermeasures. Data from 59 responding hospitals were analyzed using Chi-square, ANOVA/Kruskal-Wallis tests, and logistic regression to identify factors associated with unusual operational status and prolonged waiting for beds.
Of the 59 hospitals (18 medical centers, 20 regional hospitals, 21 district hospitals), 41 (69.5%) reported abnormal post-holiday ED operations, including severe overcrowding, hospitalization difficulties, and increased bed full notifications. In multivariate analysis, prolonged waiting for beds was the only factor significantly associated with severe operational anomalies (odds ratio [OR] = 11.31, = 0.019). Factors contributing to prolonged waiting included decreased ED nurse staffing (OR = 5.40, = 0.021), closure of general ward beds (OR = 3.26, = 0.032), and closure of ICU beds (OR = 6.27, = 0.025). A one-nurse decrease increased the odds of waiting for beds by 25% ( = 0.008), and a 1% ward bed closure increased the odds by 7.1% ( = 0.012). Although 35 hospitals implemented countermeasures such as opening extra beds or restricting transfers, only 14.3% reported significant improvement.
Reduced nursing staff and closure of general wards and ICU beds were strongly associated with prolonged waiting for beds and ED overcrowding after the Lunar New Year holiday. Current hospital-level measures have limited and temporary effects. A comprehensive approach integrating ED process optimization, hospital-wide management strategies, and community-level interventions is needed to improve bed allocation efficiency, strengthen nursing workforce sustainability, and alleviate overcrowding in Taiwan's EDs.
急诊科拥挤已成为一个全球性的普遍问题，其成因是多方面的，涵盖投入、流程和产出等领域。在台湾，全民健康保险的独特背景以及严重的护理人员短缺使情况更加复杂。农历新年假期期间急诊科需求增加，但节后拥挤的程度、原因及应对措施仍不明确。
我们在2024年农历新年假期（2月8日至14日）后的一周，针对台湾所有经认证的急诊医院的急诊科主任进行了一项描述性观察调查。问卷将运营状况与前几年同期进行比较，评估患者数量、床位可用性、人员配备、拥挤的感知原因以及实施的应对措施。使用卡方检验、方差分析/克鲁斯卡尔 - 沃利斯检验和逻辑回归对59家回复医院的数据进行分析，以确定与异常运营状况和床位等待时间延长相关的因素。
在59家医院（18家医学中心、20家地区医院、21家区医院）中，41家（69.5%）报告节后急诊科运营异常，包括严重拥挤、住院困难以及床位已满通知增加。在多变量分析中，床位等待时间延长是与严重运营异常显著相关的唯一因素（优势比[OR]=11.31，P = 0.019）。导致等待时间延长的因素包括急诊科护士人员配备减少（OR = 5.40，P = 0.021）、普通病房床位关闭（OR = 3.26，P = 0.032）以及重症监护病房床位关闭（OR = 6.27，P = 0.025）。护士减少一名会使床位等待几率增加25%（P = 0.008），病房床位关闭1%会使几率增加7.1%（P = 0.012）。尽管35家医院实施了诸如开设额外床位或限制转院等应对措施，但只有14.3%报告有显著改善。
护理人员减少以及普通病房和重症监护病房床位关闭与农历新年假期后床位等待时间延长和急诊科拥挤密切相关。目前医院层面的措施效果有限且具有临时性。需要一种综合方法，整合急诊科流程优化、全院管理策略和社区层面的干预措施，以提高床位分配效率、加强护理人员队伍的可持续性并缓解台湾急诊科的拥挤状况。
