Association of Emergency Department Length of Stay and Crowding for Patients with ST-Elevation Myocardial Infarction

Ward, Michael J.; Baker, Olesya; Schuur, Jeremiah D.

doi:10.5811/westjem.2015.8.27908

Cited by 9 publications

(9 citation statements)

References 11 publications

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“…The discharging of patients especially with high-risk clinical characteristics [51] and misleading the patients to other departments [18] have adversely impacted the patients’ health consequences. These situations could increase the time of accepting and transferring the outpatients [79] and increase patient’s admission and re-admission rates [42, 61, 64, 89] consequently a reduced discharging rate of patients [51]. The increased hospitalization of patients caused overuse of all facilities [64].…”

Section: Resultsmentioning

confidence: 99%

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Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

2019

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BackgroundEmergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals.MethodsOriginal research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase.ResultsOut of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized.ConclusionED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.

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Section: Resultsmentioning

confidence: 99%

“…Our results demonstrated that ED overcrowding negatively effects on patients’ health, healthcare delivery services and the communities [42–49, 52–61, 64, 79, 89]. The high workload caused prolonged healthcare services and clinical decision making and raised patients’ LOS [53, 54, 56, 60, 61, 63–78].…”

Section: Discussionmentioning

confidence: 96%

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

2019

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“…Previous studies have shown that the timeliness of care in time-sensitive conditions, such as myocardial infarction, is less sensitive to the adverse effects of crowding. [ 7 , 8 ] This has been explained by the use of standardized protocols to rapidly diagnose and treat these patients in the ED. [ 7 ] In our study, chest pain or arrhythmia was associated with a relatively small increase of LOS in both high- and low-acuity patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of crowding on length of stay for common chief complaints in the emergency department

2017

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Crowding in emergency departments (EDs) is associated with long lengths of stay (LOS); however, it is not known whether the effect is equal across different chief complaints.The aim of the study was to compare the effect of crowding on LOS in the 10 most common medical or surgical chief complaints in the ED.All adult visits to a university hospital ED on weekdays between 8 am and 9 pm in 2012 (n = 19,200) were stratified based on chief complaint and triage priority. The ED bed occupancy rate was measured and crowding was defined as an occupancy rate over one. The impact of crowding on LOS was calculated for the different groups.During crowding, LOS was longer among all chief complaints (P ≤.01) (except for high-acuity patients with wounds, where the study group was very small). During crowding, LOS increased the most among patients with extremity pain/swelling (145% among high-acuity patients, 125% among low-acuity patients) and flank pain (87% among high-acuity patients, 117% among low-acuity patients) and the least among patients with chest pain (32% among high-acuity patients, 45% among low-acuity patients) or arrhythmia (37% among high-acuity patients, 52% among low-acuity patients).The effect of ED crowding on LOS is unequal across different chief complaints. These findings could be used to improve the processing of specific chief complaints in the ED.

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“…Both 6,23,24,38,40,42,44,46,47,49,52 Pain: abdominal pain, 19 back Pain, 24 CVA, Stroke 6,43,44 Intubated Trauma patients 45 Sepsis 8,53 Hip Fracture 12 All Patients 5,9,38,40,42,[47][48][49]51 Adults 6,7,12,19,[22][23][24]38,[43][44][45][46]52,53 All patients 8,9,40,42,[47][48][49][50][51] < or > 8 hours 43 Quartiles 6,8,19,22-24,48,52 Both …”

Section: Dovepressmentioning

confidence: 99%

Measures of Emergency Department Crowding, a Systematic Review. How to Make Sense of a Long List

Badr

Nyce

Awan

et al. 2022

OAEM

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Emergency department (ED) crowding, a common and serious phenomenon in many countries, lacks standardized definition and measurement methods. This systematic review critically analyzes the most commonly studied ED crowding measures. We followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We searched PubMed/Medline Database for all studies published in English from January 1st, 1990, until December 1st, 2020. We used the National Institute of Health (NIH) Quality Assessment Tool to grade the included studies. The initial search yielded 2293 titles and abstracts, of whom we thoroughly reviewed 109 studies, then, after adding seven additional, included 90 in the final analysis. We excluded simple surveys, reviews, opinions, case reports, and letters to the editors. We included relevant papers published in English from 1990 to 2020. We did not grade any study as poor and graded 18 as fair and 72 as good. Most studies were conducted in the USA. The most studied crowding measures were the ED occupancy, the ED length of stay, and the ED volume. The most heterogeneous crowding measures were the boarding time and number of boarders. Except for the National ED Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN) scores, the studied measures are easy to calculate and communicate. Quality of care was the most studied outcome. The EDWIN and NEDOCS had no studies with the outcome mortality. The ED length of stay had no studies with the outcome perception of care. ED crowding was often associated with worse outcomes: higher mortality in 45% of the studies, worse quality of care in 75%, and a worse perception of care in 100%. The ED occupancy, ED volume, and ED length of stay are easy to measure, calculate and communicate, are homogenous in their definition, and were the most studied measures.

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Association of Emergency Department Length of Stay and Crowding for Patients with ST-Elevation Myocardial Infarction

Cited by 9 publications

References 11 publications

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

Effect of crowding on length of stay for common chief complaints in the emergency department

Measures of Emergency Department Crowding, a Systematic Review. How to Make Sense of a Long List

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