{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T14:32:07Z","timestamp":1793197927734,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify evidence\u2010based factors leading to the global challenge of hospital access block and inform strategies to improve emergency access performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed methods approach was followed comprising an umbrella review of published systematic reviews, qualitative analysis of the perspectives of patients and healthcare workers, and quantitative analysis of contextual factors and 6\u2009years of ambulance, emergency inpatient and ward movement records for the 25 largest public hospitals in Queensland, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A key set of findings and recommendations were identified to improve emergency access that are practical and actionable. These comprise the introduction of inpatient discharge metrics and monitoring to shift focus from the front door of hospitals to the \u2018back door\u2019; increasing support for primary care, community care, aged care, NDIS and vulnerable groups; maintaining demand\u2010side strategies such as increasing inpatient\u2010equivalent care alternatives (e.g., hospital in the home, acute care within nursing home services); investment in prehospital flow; improving hospital processes such as extended\u2010hour discharge lounges; improving workforce; and revising funding policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study findings fill a gap in the evidence regarding challenges and recommendations for improving patient flow within hospital emergency departments and across the broader health system. Focussing efforts at the \u2018back end\u2019 of the inpatient journey is a critical step to improve emergency care outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70327","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:18:10Z","timestamp":1788758290000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Access Block and Ambulance Ramping: The Canaries of the Healthcare System"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9025-1441","authenticated-orcid":false,"given":"Justin","family":"Boyle","sequence":"first","affiliation":[{"name":"CSIRO  Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2260-4142","authenticated-orcid":false,"given":"Andrew","family":"Staib","sequence":"additional","affiliation":[{"name":"Queensland Department of Health Metro South Hospital and Health Service District  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clair","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Queensland Department of Health Metro North Hospital and Health Service District  Brisbane Australia"},{"name":"Queensland Digital Health Centre (QDHeC) The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6125-8871","authenticated-orcid":false,"given":"Sankalp","family":"Khanna","sequence":"additional","affiliation":[{"name":"CSIRO  Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9672-303X","authenticated-orcid":false,"given":"Ibrahima","family":"Diouf","sequence":"additional","affiliation":[{"name":"CSIRO  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-1963","authenticated-orcid":false,"given":"Hamed","family":"Hassanzadeh","sequence":"additional","affiliation":[{"name":"CSIRO  Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1772-7911","authenticated-orcid":false,"given":"Jin","family":"Yoon","sequence":"additional","affiliation":[{"name":"CSIRO  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6050-6423","authenticated-orcid":false,"given":"Vahid","family":"Riahi","sequence":"additional","affiliation":[{"name":"CSIRO  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4756-2364","authenticated-orcid":false,"given":"Mahnaz","family":"Samadbeik","sequence":"additional","affiliation":[{"name":"Queensland Digital Health Centre (QDHeC) The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4645-613X","authenticated-orcid":false,"given":"Emma","family":"Bosley","sequence":"additional","affiliation":[{"name":"Queensland Ambulance Service  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Lind","sequence":"additional","affiliation":[{"name":"Queensland Department of Health Gold Coast Hospital and Health Service District  Gold Coast Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Australian Institute of Health and Welfare (AIHW) \u201cAustralian Hospital Statistics 2002\u201303 \u201d(2004) AIHW Cat. 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