Are Smaller Emergency Departments More Prone to Volume Variability?

Autor: Nourazari S; California State University, Long Beach, Department of Health Care Administration, Long Beach, California., Harding JW; Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts., Davis SR; LogixHealth, Inc., Bedford, Massachusetts., Litvak O; LogixHealth, Inc., Bedford, Massachusetts., Traub SJ; Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island., Sanchez LD; Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: The western journal of emergency medicine [West J Emerg Med] 2021 Jul 14; Vol. 22 (4), pp. 878-881. Date of Electronic Publication: 2021 Jul 14.
DOI: 10.5811/westjem.2021.2.49749
Abstrakt: Introduction: Daily patient volume in emergency departments (ED) varies considerably between days and sites. Although studies have attempted to define "high-volume" days, no standard definition exists. Furthermore, it is not clear whether the frequency of high-volume days, by any definition, is related to the size of an ED. We aimed to determine the correlation between ED size and the frequency of high-volume days for various volume thresholds, and to develop a measure to identify high-volume days.
Methods: We queried retrospective patient arrival data including 1,682,374 patient visits from 32 EDs in 12 states between July 1, 2018-June 30, 2019 and developed linear regression models to determine the correlation between ED size and volume variability. In addition, we performed a regression analysis and applied the Pearson correlation test to investigate the significance of median daily volumes with respect to the percent of days that crossed four volume thresholds ranging from 5-20% (in 5% increments) greater than each site's median daily volume.
Results: We found a strong negative correlation between ED median daily volume and volume variability (R 2 = 81.0%; P < 0.0001). In addition, the four regression models for the percent of days exceeding specified thresholds greater than their daily median volumes had R 2 values of 49.4%, 61.2%, 70.0%, and 71.8%, respectively, all with P < 0.0001.
Conclusion: We sought to determine whether smaller EDs experience high-volume days more frequently than larger EDs. We found that high-volume days, when defined as days with a count of arrivals at or above certain median-based thresholds, are significantly more likely to occur in lower-volume EDs than in higher-volume EDs. To the extent that EDs allocate resources and plan to staff based on median volumes, these results suggest that smaller EDs are more likely to experience unpredictable, volume-based staffing challenges and operational costs. Given the lack of a standard measure to define a high-volume day in an ED, we recommend 10% above the median daily volume as a metric, for its relevance, generalizability across a broad range of EDs, and computational simplicity.
Databáze: MEDLINE
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