Association Between Hospital Bed Occupancy and Outcomes in Emergency Care: A Cohort Study in Stockholm Region, Sweden, 2012 to 2016

Ugglas, Björn af; Djärv, Therese; Ljungman, Petter; Holzmann, Martin J.

doi:10.1016/j.annemergmed.2019.11.009

Cited by 17 publications

(19 citation statements)

References 20 publications

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“…A key output factor was the reduced bed occupancy in the emergency wards that improved the service level for the ED. [ 23 ] This is in line with the findings of Asplin et al that “the most frequently cited reason for ED crowding is the inability to move admitted patients from the ED to an inpatient bed” [ 15 ]. We also identified a statistically significant correlation between mean ED LOS and mean emergency ward occupancy by phase.…”

Section: Discussionsupporting

confidence: 81%

Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden

Ugglas

Skyttberg

Wladis

et al. 2020

Scand J Trauma Resusc Emerg Med

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Objectives COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. Methods Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. Results As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373–399) minutes to 307 (297–317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55–0.99). Conclusions It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design.

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Section: Discussionsupporting

confidence: 81%

Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden

Ugglas

Skyttberg

Wladis

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…According to a national statistics database [25], the average hospital bed occupancy weighted with the visit volumes included in the study was 101% in Stockholm, 92% in Skåne and 81% in Ö stergötland. In an earlier study we found that a high hospital bed occupancy is closely linked to an increased ED workload with longer LOS and fewer admissions to inpatient care suggesting tougher prioritizations [26]. It is possible that the lower bed occupancy level in Skåne and Ö stergötland functions as a buffer, limiting the most dangerous consequences of ED crowding.…”

Section: Discussionmentioning

confidence: 85%

Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR)

et al. 2021

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Objectives There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality. Methods This was an observational cohort study including visits from 14 EDs in Sweden 2015–2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed. Results 2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01–1.12) in the moderate crowding category, and 1.11 (1.01–1.22) in the high category. Conclusions The association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role.

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“…The average number of beds of the two hospitals in this study was 293 and 219 compared to 420 beds at the hospital in Blom's studies. 15,16 In the Australian study, critical levels of bed occupancy are observed at higher occupancy levels at smaller hospitals. 23 Deterioration in ED performance, here succinctly defined as an increasing ED length of stay for admitted patients but not for discharged patients, is seen at an occupancy level of 98% in smaller hospitals with less than 300 beds compared to 86% in larger hospitals with more than 900 beds.…”

Section: Association Between Hospital Admission and The Clinical Vamentioning

confidence: 99%

“…14 A few studies explore if there is an association between hospital bed occupancy and the likelihood of admission from the ED. In one survey by Blom et al of all ED visits 15 and another of ED visits with acute abdominal pain, 16 the likelihood of admission decreases when hospital bed occupancy increases. Furthermore, in a study by af Ugglas et al of all patients older than 17 years in six EDs, 17 higher hospital occupancy is associated with a decline in admissions for inpatient care.…”

Section: Introductionmentioning

confidence: 99%

“…In one survey by Blom et al of all ED visits 15 and another of ED visits with acute abdominal pain, 16 the likelihood of admission decreases when hospital bed occupancy increases. Furthermore, in a study by af Ugglas et al of all patients older than 17 years in six EDs, 17 higher hospital occupancy is associated with a decline in admissions for inpatient care. We aimed to assess whether these previous results suggesting an association between hospital bed occupancy and likelihood of admission to hospital from the ED can be reproduced in a different study population.…”

Section: Introductionmentioning

confidence: 99%

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Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission

Heyman

Engström

Baigi

et al. 2020

Health Planning & Management

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Background: The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. Methods: A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Association Between Hospital Bed Occupancy and Outcomes in Emergency Care: A Cohort Study in Stockholm Region, Sweden, 2012 to 2016

Cited by 17 publications

References 20 publications

Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden

Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden

Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR)

Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission

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