Does crowding influence emergency department treatment time and disposition?

Autor: Hoot NR; Department of Emergency Medicine McGovern Medical School at the University of Texas Health Science Center at Houston Houston Texas USA., Banuelos RC; Department of Emergency Medicine McGovern Medical School at the University of Texas Health Science Center at Houston Houston Texas USA., Chathampally Y; Department of Emergency Medicine McGovern Medical School at the University of Texas Health Science Center at Houston Houston Texas USA., Robinson DJ; Department of Emergency Medicine McGovern Medical School at the University of Texas Health Science Center at Houston Houston Texas USA., Voronin BW; Department of Emergency Medicine McGovern Medical School at the University of Texas Health Science Center at Houston Houston Texas USA., Chambers KA; Department of Emergency Medicine McGovern Medical School at the University of Texas Health Science Center at Houston Houston Texas USA.
Jazyk: angličtina
Zdroj: Journal of the American College of Emergency Physicians open [J Am Coll Emerg Physicians Open] 2020 Dec 03; Vol. 2 (1), pp. e12324. Date of Electronic Publication: 2020 Dec 03 (Print Publication: 2021).
DOI: 10.1002/emp2.12324
Abstrakt: Objective: The objective of this study was to determine whether crowding influences treatment times and disposition decisions for emergency department (ED) patients.
Methods: We conducted a retrospective cohort study at 2 hospitals from January 1, 2014, to July 1, 2014. Adult ED visits with dispositions of discharge, admission, or transfer were included. Treatment times were modeled by linear regression with log-transformation; disposition decisions (admission or transfer vs discharge) were modeled by logistic regression. Both models adjusted for chief complaint, Emergency Severity Index (ESI), and 4 crowding metrics in quartiles: waiting count, treatment count, boarding count, and National Emergency Department Overcrowding Scale.
Results: We included 21,382 visits at site A (12.9% excluded) and 29,193 at site B (15.0% excluded). Respective quartiles of treatment count increased treatment times by 7.1%, 10.5%, and 13.3% at site A ( P  < 0.001) and by 4.0%, 6.5%, and 10.2% at site B ( P  < 0.001). The fourth quartile of treatment count increased estimates of treatment time for patients with chest pain and ESI level 2 from 2.5 to 2.9 hours at site A (20 minutes) and from 3.0 to 3.3 hours at site B (18 minutes). Treatment times decreased with quartiles of waiting count by 5.6%, 7.2%, and 7.3% at site B ( P  < 0.001). Odds of admission or transfer increased with quartiles of waiting count by 8.7%, 9.6%, and 20.3% at site A ( P  = 0.011) and for the third (11.7%) and fourth quartiles (27.3%) at site B ( P  < 0.001).
Conclusions: Local crowding influenced ED treatment times and disposition decisions at 2 hospitals after adjusting for chief complaint and ESI.
Competing Interests: The authors declare no conflict of interest.
(© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.)
Databáze: MEDLINE
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