Quantifying access block in a South African major trauma centre: a retrospective exploratory study

Introduction Access block is defined as a delay in access to inpatient beds for patients from the Emergency Department (ED). It is a key contributor to ED overcrowding and is associated with worse patient outcomes. This study aimed to quantify access block within Chris Hani Baragwanath Academic Hospital’s Trauma Emergency Unit (TEU) and identify associated factors. Methods A retrospective review was conducted of all consecutive patients presenting to the TEU resuscitation room from January 1 to December 31, 2022. Patients aged <14 years (<10 for burns) and those managed by other services were excluded. Data on demographics, clinical characteristics, resuscitation length-of-stay, interventions, and disposition were analysed. Access block was defined as a >8 h delay for the purposes of this study. Univariable analyses were performed to identify associations with access block. Results During the study period, 2270 patients were admitted from the resuscitation room to the ward without first requiring the operating theatre, of whom 2091 had a recorded length-of-stay. Access block affected 61.3%. In unadjusted analysis, factors significantly associated with access block included a requirement for CT imaging (OR 4.17), intensive care unit (ICU) admission (OR 3.69), mechanical ventilation (OR 2.10), blunt mechanisms of injury (OR 2.19), presenting at night (OR 1.85), and an arrival shock index ≥1 (OR 1.32). Conversely, presenting with penetrating trauma (OR 0.61), burns (OR 0.50), and undergoing intercostal catheter insertion (OR 0.53) were associated with significantly lower odds of access block. Time-to-CT was significantly longer in patients with access block (366 vs 165 min; P < 0.01). Patients requiring mechanical ventilation had significantly longer length-of-stay (834 vs 631 min; P < 0.01), even once time-to-CT was accounted for. Conclusion Most admitted patients were affected by access block. Associated factors included CT imaging, ICU admission, mechanical ventilation, and presentation at night. This corroborates the international consensus that whole-of-system solutions are necessary to remedy it.