Hospital Access Block: A Scoping Review

Introduction: The overarching objective of this scoping review was to explore the breadth of health care literature in attempts to identify current strategies that hospitals adopt to improve patient bed flow, reduce access and exit block while optimizing patient care.

Methods: PubMed, CINAHL, Embase, Proquest, and Cochrane electronic library databases supported literature search in March 2021. Scholarly articles that met the 3 eligibility criteria—access block causes, effects, and solutions—were considered. Joanna Briggs Institute Guidelines supported first- and second-level literary screening processes.

Results: The synthesis included 43 references. Most initiatives addressed access (n = 15), followed by care (n = 16) and then community (n = 9), with a further 3 articles providing commentary across all 3 domains (n = 3). Evidence supported Lean principles in both emergency department and inpatient sector. Lean principles addressing access included physician-led ED triage models, point-of-care testing, overcapacity protocols, mental health team collocation models, and fast-track services. Inpatient care Lean concepts validated gains in multidisciplinary rounds, appropriate allocation of allied health services with a 7-days-a-week model, staggering of elective surgeries, journey boards usage, transit lounges, and lateral transfers. Most literature addressing the backend was narrative in nature, theorized, and advocating for solutions and policy reform.

Discussion: This study addressed aims and identified current strategies that hospitals adopt to tackle access block while guaranteeing patient care. Government-supported research to map out evidence-based models of care that address exit block and demonstrate efficiencies is required to optimize access to care in the community.