Emergency department crowding in the Netherlands; evaluation of a real-time ambulance diversion dashboard

Emergency department crowding in the Netherlands; evaluation of a real-time ambulance diversion dashboard

Crowding, Emergency Service, Ambulance diversions, Emergency department, Emergency room,
Humans, The Netherlands

Abstract
Background Emergency department (ED) crowding is a growing concern worldwide and associated with negative
effects. In 2013, 68% of Dutch ED-managers experienced crowding on several days of the week. This resulted into the
introduction in phases of an ambulance diversion dashboard, in order to influence ED input. Increasing numbers of
Dutch EDs have implemented this dashboard, visualizing regional ambulance diversions by means of a traffic light.
Methods This is a descriptive study of a nationwide online survey of Dutch EDs, conducted between January and
October 2023. It included both qualitative and quantitative questions. The outcomes and analysis are derived from
descriptive data of respondents’ experience of crowding as well as their usage and perceived effectiveness of the
ambulance diversions dashboard.
Results At the time of the survey, 62 of 82 Dutch EDs (75.6%) actually used the dashboard, of which 56 EDs
responded (90.3% response rate). 69.7% Of ED managers experienced ED crowding more than three times a week.
Of the respondents using the dashboard, 52.8% reported it only occasionally alleviates ED inflow. The purported
reasons are the limited number of patients affected by the red light (ambulance diversion) and the presence of
regional crowding. The effects of the orange light (impending ambulance diversion) on ED input differ greatly
among hospitals, mostly due to their own internal agreements. In accordance, many respondents (53.6%) expressed
dissatisfaction with the resources available to them to alleviate crowding.
Conclusion After conducting a national survey, ED crowding is reported as a persisting nationwide problem with its
prevalence largely unchanged since the introduction of the ambulance diversion dashboard. Most hospitals reported
having insufficient resources to alleviate it. The effects of the ambulance diversion dashboard to decrease crowding
are apparently limited because it affects a small portion of total ED presentations and because of the influence
of regional crowding. The main function of the orange light is to increase ED throughput and output rather than
reducing ED input.
Keywords Crowding, Emergency Service, Ambulance diversions, Emergency department, Emergency room,
Humans, The Netherlands

E. C. M. Baan-Kooman1*, S. Mol1

, M. C. van der Linden2

, M. I. Gaakeer3

and V. A. de Ridder4

https://doi.org/10.1186/s12245-024-00784-1

2025

Peri Irawan

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