Association between ED crowding and delay in resuscitation effort

Hong, Ki Jeong; Shin, Sang Do; Song, Kyoung Jun; Chul, Won; Cho, Jin Seong

doi:10.1016/j.ajem.2012.09.029

Cited by 42 publications

(27 citation statements)

References 20 publications

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“…Investigations at MidStaffordshire revealed that highly dysfunctional interfaces between ED and in-patient units were associated with more deaths concentrated among patients presenting acutely with cardiovascular disorders. 28 Other researchers have observed associations between measures of ED stays and overcrowding and delays in resuscitation and treatment of acutely ill patients, 29,30 higher risk of adverse cardiovascular events in patients presenting with chest pain 31 and suboptimal timing of antibiotic administration 32 and increased mortality 33 in patients presenting with communityacquired pneumonia. In the present study, NEAT interventions were associated with reduced mortality rates in patients presenting with acute circulatory or respiratory diseases.…”

Section: -27mentioning

confidence: 99%

Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

Sullivan¹,

Staib²,

Eley³

et al. 2016

Aust. Health Review

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Objective. The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014.Methods. We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes.Results. The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17 022) in 2011 to 1.2% (202/17 162) in 2013 (P < 0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P = 0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P < 0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P = 0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P = 0.038) in 2011 and 1.3% versus 1.1% (P = 0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3.4%, respectively; P < 0.001 for both comparisons). Mode of transport to the ED or triage category was not associated with changes in mortality. These analyses took account of any possible confounding resulting from differences over time in emergency admission rates.Conclusions. Improved NEAT compliance as a result of clinical redesign is associated with improved in-patient mortality among particular subgroups of emergency admissions, namely older patients with complex medical conditions, those presenting after hours and on weekends and those presenting with time-sensitive acute cardiorespiratory conditions. HEALTH SERVICE RESEARCHWhat is known about the topic? Clinical redesign aimed at improving compliance with NEAT and reducing time spent within the ED of acutely admitted patients has been associated with reduced mortality. To date, no study has attempted to identify subgroups of patients who potentially derive the greatest benefit from improved NEAT compliance in terms of reduced risk of in-patient death. It also remains unclear as t...

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Section: -27mentioning

confidence: 99%

Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

Sullivan¹,

Staib²,

Eley³

et al. 2016

Aust. Health Review

View full text Add to dashboard Cite

show abstract

“…Patients who suddenly become unstable may be not recognized until it is too late. Patients have been found apneic, unconscious, or in shock laying unmonitored on hallway gurneys [37].…”

Section: Poor Outcomes From Hallway Carementioning

confidence: 99%

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

Richards

Linden

Derlet

2014

Advances in Emergency Medicine

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Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care.

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“…As the ED system is overburdened by crowding, the quality and safety of emergency care decline. Direct consequences of crowding include increased wait times [4,5,10,11], increased rates of patients leaving without being seen [7,[9][10][11], prolonged LOS [3,7,8], higher patient dissatisfaction [3, 5, 7-9, 11, 12], poorer clinical outcomes [3,5,7,9], delay in time-sensitive interventions [4,7,10,11,[13][14][15], increased adverse events [7,10], increased ambulance diversion [3-5, 7-11], decreased regional disaster response capacity [3], increased morbidity and mortality [3,4,7,9,10,[16][17][18], increased number of patients returning to the ED [7], and ED staff dissatisfaction and burnout [5,8,10]. Crowding is attributed to 31% of sentinel events in the ED [4].…”

Section: Discussionmentioning

confidence: 99%

Implementing Triage Standing Orders in the Emergency Department Leads to Reduced Physician-to-Disposition Times

Hwang

Payton

Weeks

et al. 2016

Advances in Emergency Medicine

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Emergency departments (EDs) throughout USA have improvised various processes to curb the "national epidemic" termed ED "crowding." Standing orders (SOs), one such process, are medical orders approved by the medical director and entered by nurses when patients cannot be seen expeditiously, expediting medical decision-making and decreasing length of stay (LOS) and time to disposition. This retrospective cohort study evaluates the impact of SOs on ED LOS and disposition time at a large university ED. Results indicate that SOs significantly improve ED throughput by reducing disposition time by up to 16.9% ( = 0.04), which is especially significant in busy ED settings. SOs by themselves are not sufficient for a complete diagnostic assessment. Strategies such as having a provider in the waiting area may help make key decisions earlier.

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Association between ED crowding and delay in resuscitation effort

Cited by 42 publications

References 20 publications

Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

Implementing Triage Standing Orders in the Emergency Department Leads to Reduced Physician-to-Disposition Times

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