Objectives: The objective was to evaluate the association between hospital census variables and emergency department (ED) length of stay (LOS). This may give insights into future strategies to relieve ED crowding.Methods: This multicenter cohort study captured ED LOS and disposition for all ED patients in five hospitals during five 1-week study periods. A stepwise multiple regression analysis was used to examine associations between ED LOS and various hospital census parameters.Results: Data were analyzed on 27,325 patients on 161 study days. A significant positive relationship was demonstrated between median ED LOS and intensive care unit (ICU) census, cardiac telemetry census, and the percentage of ED patients admitted each day. There was no relationship in this cohort between ED LOS and ED volume, total hospital occupancy rate, or the number of scheduled cardiac or surgical procedures. Conclusions:In multiple hospital settings, ED LOS is correlated with the number of admissions and census of the higher acuity nursing units, more so than the number of ED patients each day, particularly in larger hospitals with busier EDs. Streamlining ED admissions and improving availability of inpatient critical care beds may reduce ED LOS.ACADEMIC EMERGENCY MEDICINE 2009; 16:597-602 ª

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Victims of sudden infant death syndrome (SIDS) have been shown to have pathologic abnormalities consistent with chronic hypoxia.1-7 Two groups of infants at high risk of dying of SIDS, near miss infants and subsequent siblings of SIDS victims, have been studied in attempts to demonstrate physiologic abnormalities that could account for these pathologic findings. Investigators have found abnormalities in breathing pattern and the respiratory control system in the former consisting of prolonged sleep apnea, excessive short apnea, periodic breathing, hypoventilation, and depressed response to hypercarbia.8-13 However, studies in the SIDS sibling group have demonstrated varying results of excessive periodic breathing in the home14 and decreased apnea in the laboratory.15

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OBJECTIVES: Emergency Department [ED] overcrowding is a national problem. This study evaluates the effect of a provider/nurse triage model (Rapid Evaluation Unit, REU) designed to improve the efficiency of the ED on ED patient volume and ambulance diversion hours. METHODS: Data on daily patient counts [inpatient, ED] and ambulance diversion hours for a single hospital in Baltimore were used to evaluate the impact of REU on hospital performance. Data covered 2008, the year before the REU was implemented, and 2009 during which the REU was implemented incrementally. The REU was operating on Monday-Wednesday from January 1 st through March 31 st , and then Monday through Friday from April 1 st through December 31 st . Regression models were estimated for the daily counts for admissions, ED visits and ambulance diversion days controlling for time trend effects, day of the week and month of the year. A spline functional form was used to test the effects of the REU on pre-2009 time trends and to improve model fit. Models were adjusted for autocorrelation and heteroskedasticity as needed. RESULTS: The REU significantly increased ED patient visit counts by 5.5 visits per day [pϽ0.01] without increasing the number of hours the hospital was diverting ambulances due to over crowding [Ϫ0.83 hours per day, pϾ0.05]. For ED visits, all months exhibited significantly higher daily ED visit counts than in December, ranging from ϩ9 to ϩ28 visits per day. The early work week [Monday-Wednesday] also exhibited significantly higher rates of ED visits than Saturday [range: 5-12 visits per day]. CONCLUSIONS: The REU was effective at increasing ED visits without increasing ambulance diversion hours. We theorize that this may be due to a reduction in the time spent by patients waiting for treatment.

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