Association of sudden in-hospital cardiac arrest with emergency department crowding

Bae²,

et al. 2020

Preprint

Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, associations between emergency department crowding and occurrence of both in-hospital cardiac arrest and out-of-hospital cardiac arrest have not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital and out-of-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and out-of-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest and 442 patients had out-of-hospital cardiac arrest. In-hospital cardiac arrest patients compared to out-of-hospital cardiac arrest patients had a significantly higher return of spontaneous circulation rates (16.5% vs. 4.8%; P < .01) and better neurologic outcomes at discharge (cerebral performance category scales 4.7 vs. 4.0; P < .01). Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Out-of-hospital cardiac arrest incidence was negatively correlated with emergency department occupancy (ρ = -0.79, P = .04). Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence, while occupancy rate was negatively correlated with out-of-hospital cardiac arrest incidence.

Section: Discussionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Bae²,

et al. 2020

Preprint

“…We found that higher maximum ED occupancy rates, which may indicate the most hazardous and chaotic times in the ED, were strongly associated with sudden IHCA occurrence. In a recent observational retrospective study conducted by Chang et al, ED crowding was roughly associated with IHCA occurrence [23]. In this study, ED bed occupancy rate (EDBOR) was used as an overcrowding index by calculating the ratio of the total number of filled beds divided by the total number of licensed ED beds.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this study is the first study that compared the relationship between IHCA occurrence and ED occupancy rate at these times. Chang et al's study used three arbitrary cutoff values of the bed occupancy rate [23], but ED occupancy rate crowding measures should be dealt with as a continuous variable because there is no standard threshold. In our study, we normalized with IHCA incidence per hour for each ED occupancy rate interval (0.2 increment for the critical zone and 0.4 increment for the urgent zone) and found there was a strong association between unexpected IHCA and ED occupancy rate.…”

Section: Discussionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Bae²,

et al. 2020

Crit Care

Background: Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, the association between emergency department crowding and the occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and the incidence of in-hospital cardiac arrest. Methods: A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at the time of presentation of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is the association between the incidence of inhospital cardiac arrest and emergency department occupancy rates. Results: During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality.

“…In a recent observational retrospective study conducted by Chang et al, ED crowding was roughly associated with IHCA occurrence. [23] In this study, ED bed occupancy rate (EDBOR) was used as an overcrowding index by calculating the ratio of the total number of lled beds divided by the total number of licensed ED beds.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this study is the rst study that compared the relationship between IHCA occurrence and ED occupancy rate at these times. Chang's study used three arbitrary cut-off values of the bed occupancy rate, [23] but ED occupancy rate crowding measures should be dealt with as a continuous variable because there is no standard threshold. In our study, we normalized with IHCA incidence per hour for each ED occupancy rate interval (0.2 increment for critical zone and 0.4 increment for urgent zone) and found there was a strong association between unexpected IHCA and ED occupancy rate.…”

Section: Discussionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Bae²,

et al. 2020

Preprint

Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, association between emergency department crowding and occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality. Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest.