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Research - Over-Census / Transit Project

Research Project Overview

Evaluation of ‘over-census’ patient transfers from ED to the ward.


Lack of access to ward beds for admitted Emergency Department patients is a major contributor to ED bed-block and is associated with increased clinical errors, prolonged hospital length of stay and increased hospital mortality.

In August 2012, Liverpool hospital introduced an ‘over census’ policy as one means of facilitating transfer of admitted ED patients to the ward, even when no ward bed was immediately available.

Each non-critical care hospital ward was required to accept one additional patient above their usual bed numbers at 8am each weekday morning. Suitable patients were identified in the ED by senior medical staff and had already been accepted by an admitting team and were clinically stable.

Since the introduction of this policy, up to 15 patients per day have been transferred from the ED to wards without an identified empty bed. This has been associated with a significant reduction in ED ‘bed block’ and an improvement in ED waiting times and length of stay.

The purpose of this project will be to evaluate the safety of the ‘over census’ process (measured by the number of adverse events) and to prospectively evaluate the flow of ‘over census’ patients once they reach the ward.



Conference Presentations

  • 12th International Conference for Emergency Nurses (ICEN): October 2014 (presentation)

  • 31st Australasian College for Emergency Medicine (ACEM) Annual Scientific Committee: December 2014 (presentation)

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