Know the flow: A mixed-method analysis of patient flow through a regional ED

Alex Pryce1,2, Maria Unwin1,2, Leigh Kinsman1,2, Damhnat McCann2

1Tasmanian Health Service, 2University of Tasmania


The equivalent of one in three Australians present to an Emergency Department (ED) in a single 12-month period. The increasing demand for ED care and ED crowding has heightened focus on the movement of patients through the ED (ED patient flow). We set out to map the patient flow through a regional ED in a 300-bed hospital with the aim of recording the movement of patients through the input, throughput, and output phases, and identifying factors contributing to extended ED length of stay.


We undertook a mixed methods study based on retrospective presentation data, prospective observational data and a subsequent focus group with the observers based in a regional Tasmanian hospital ED.


Key findings identified from the retrospective analysis of 89,013 ED presentations and observational data from 382 patient journeys included: arrival numbers were not a predictor of ED crowding; waiting times at triage and in the waiting room created significant risks to patient safety; ED crowding triggers the use of ‘makeshift’ space to assess and treat patients; and access block is the major contributor to crowding. Analysis from the focus group identified four key themes: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles.


Our mixed methods observational study revealed an environment of crowding and chaos that impacted patient flow and compromised patient and staff safety. Despite this, ED staff maintained outstanding standards of care.

This presentation will highlight key findings and stimulate discussion regarding the need for strategies to address ED crowding that address contributing factors external to ED.


Alex Pryce is an Associate Nurse Unit Manager (ANUM) at the Launceston General Hospital ED. Alex also works with undergraduate students for the University of Tasmania School of Nursing and in the high-fidelity sim-lab for the Launceston Clinical School. Data analysis for this project was undertaken as part of a Nursing Honours program. This project is a collaboration between the Tasmanian Health Service and the University of Tasmania.