To our knowledge, this study is the first to evaluate emergency crowding by immigrants in southern China. The number of patients visiting the ED and their LOS were higher from November to March of next year. The demographic characteristics were different between local and immigrant patients.
In recent years, because of air pollution and severe weather, a large number of retired people migrate to the southern coast in warmer months (9–10). Hainan Province is the most popular destination and attracted a large number of immigrants after 2009 (9–10). There were more than one million immigrants in Hainan Province in 2015, which was double the number in 2010 (9–10).
The period with the highest number of patients—November to March of next year—was designated the “medical boom season” by hospital staff. The months from November to April are often the coldest in mainland China, especially in northeast China. Our sample included many people from the north and northeast, including Heilongjiang, Beijing, Jilin, and Liaoning. Previous studies showed that many retired people, especially those with chronic diseases, migrated from these provinces to Hainan (9–10, 12,14). It has been reported that the good weather conditions in Hainan can improve stroke recovery, blood pressure, and chronic conditions, including pulmonary diseases (12–16). This fact could explain why relatively more patients with respiratory and cardiovascular diseases visited the ED in Hainan.
Emergency crowding in our hospital was not worse than the problem reported in larger cities in China, including Beijing, Shanghai, and Hangzhou (6–8). The mean LOS in the ED was 1.2 days, and only 50% of the patients visiting this department received inpatient care. However, in Beijing, some patients stayed more than 5 days in the observation room, and only approximately 10% could wait for admission. In Shanghai, 12% were admitted to hospital wards, and some patients had to stay in the ED for extended periods, even more than 1 month. Similar results were found in Zhejiang. The problem of emergency overcrowding in China seems to be worse than in other countries. In Australia and the United Kingdom, the threshold of access block is 8 and 4 hours, respectively (3, 4).
The number of patients with respiratory, digestive, or cardiovascular diseases who were not admitted to the ward and had to spend a long time in the ED was higher than that of patients with other conditions. This result may be due to the limited capacity of specialized wards and other factors. Previous studies showed that specialized wards refused to admit patients with multiple organ dysfunction syndrome (6–8). Our results indicated that patients requiring emergency operations were transferred from the resuscitation room faster than other patients, and this may be because the surgical patients in our hospital were given priority to inpatient care.
The present study makes a significant contribution to the problem of emergency overcrowding. In the “medical boom season,” hospitals need to hire additional staff and provide more ward beds, and the government should take measures to improve local hospitals’ capacity to serve for more patients. The present study has limitations. First, this study was performed in a single center and, therefore, did not reflect the situation in the entire province. Second, data were incomplete because we did not determine the distances traveled by migrants and commodity factors affecting the long stay in the ED. The patients discharged from hospital after recovery and those discharged without receiving advanced therapy were not distinguished.