Characteristics of ED crowding in the Lazio Region (Italy) and short-term health outcomes

Abstract

The effect of emergency department (ED) crowding on patient care has been studied for several years in the scientific literature. We evaluate the association between ED crowding and short-term mortality and hospitalization in the Lazio region (Italy) using two different measures. A cohort of visits in the Lazio region ED during 2012-2014 was enrolled. Only discharged patients were selected. ED crowding was estimated using two measures, length of stay (LOS), and Emergency Department volume (EDV). LOS was defined as the interval of time from entrance to discharge; EDV was defined at the time of each new entrance in ED. The outcomes under study were mortality and hospitalization within 7 days from ED discharge. A multivariate logistic model was performed (Odds Ratios, ORs, 95% CI). The cohort includes 2,344,572 visits. ED crowding is associated with an increased risk of short-term hospitalization using both LOS and EDV as exposures (LOS 1-2 h: OR = 1.71, 95% CI 1.66-1.76, LOS 2-5 h: OR = 1.38, 95% CI 1.34-1.43, LOS > 5 h OR = 1.45 95% CI 1.40-1.50 compared to patients with 1 h of LOS; EDV 75°-95° percentile: OR = 1.02, 95% CI 0.99-1.05 and EDV > 95° percentile: OR = 1.06, 95% CI 1.01-1.11 compared to patients with a EDV < 75° percentile upon arrival). Increased risk of short-term mortality is found with increasing level of LOS. High levels of EDV at the time of patients' arrival and longer LOS in ED are associated with greater risks of hospitalization for patients discharged 7 days before. LOS in ED is also associated with an increased risk of mortality.

Emergency department crowding associated with increased 30‐day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016

“…Studies investigating the association between crowding and mortality are many, but the quality is inconsistent. We identified 8 high‐quality articles 2–9 that we could learn from when designing our study. Three of these 8 articles 3,6,7 both included a large enough sample from multiple EDs and were properly designed to manage confounding due to case mix.…”

Patients who leave Emergency Department without being seen or during treatment in the Lazio Region (Central Italy): Determinants and short term outcomes

“…Information related to ED crowding was defined by counting the number of patients present in the ED at the time of each new arrival. If this number resulted in greater than the 75° percentile of the distribution of patients generally present in the ED at that time-band, the ED was defined as crowded [32].…”

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

“…Retrospective [5][6][7][8][9]12,13,[17][18][19][21][22][23][24][25][26][27][28][29][30]32,33,[36][37][38] Prospective 10,11,15,20,34,35,42 Survey 14,39 31 Good 4 Fair ED LOS 2003-2019 5,6,8,9,12,19,[22][23][24]38,40,[42][43][44][45][46][47][48][49][50]…”

“…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 …”