In Queensland, access block was first observed in the peripheral urban hospitals in the Brisbane and Gold Coast area. As the absolute and relative bed capacity of public hospitals declined in the period 1999–2002, access block in Queensland's largest hospitals increased from a barely manageable average of less than 10% (Australasian College for Emergency Medicine/Australian Council on Healthcare Standards definition: proportion of admissions with total time in the emergency department longer than eight hours) to an average of about 14% in financial year 2001–02. Various administrative analyses have shown that the deleterious effects of access block start to become apparent at levels greater than 5%, and that these dysfunctional levels of access block occur when hospital occupancy consistently exceeds 95%. Other observations on Queensland data are that, generally speaking, access block is less of a problem in provincial centres than in metropolitan areas, and that hospitals with the best elective surgery performance tend to have the worst access block performance, and vice versa.

The best-performing large hospital in Queensland in relation to access block is the Royal Brisbane Hospital (RBH), which had an average 6.2% in 2001–02. RBH is believed to be one of only two major hospitals in Australia that had no requests for ambulance bypass in 2001–02.

This outcome has been achieved through considerable research and innovation and a management view that the RBH cannot go on ambulance bypass, as its emergency department (ED) is the sole department servicing a catchment area population of some 550 000, and because the other EDs in Brisbane do not have the capacity to absorb the additional workload if RBH ED closed its doors, even for a few hours.

Over the past decade the hospital has implemented many strategies aimed at optimising the efficiency of the ED, the acute care process and discharge procedures. These are summarised in the Box. All of these strategies are believed to have had some benefit, but the most significant are the ED Short Stay Unit and the Medical Assessment and Planning Unit.

It is known that small improvements in bed availability (ie, 5–10 beds) can cumulatively have a very substantial impact on access block, so RBH's current focus is on precision bed management through improved information systems and processes, including geographic information systems (which map the geography of the hospital against variables such as patient numbers, staff numbers, and nurse dependency). The objective is to maximise the identification of the relationships and correlations that exist in separate data sources within the hospital to precisely measure and predict demand and throughput in real time and to communicate that information throughout the organisation. Once this strategy has been exhausted, access block will only be able to be avoided through greater reductions in elective surgical throughput or an increase in system bed capacity, particularly during periods of peak demand.