Effect of Emergency Department Crowding on Outcomes of Admitted Patients

Abstract

Study objective Emergency department (ED) crowding is a prevalent health delivery problem and may adversely affect the outcomes of patients requiring admission. We assess the association of ED crowding with subsequent outcomes in a general population of hospitalized patients. Methods We performed a retrospective cohort analysis of patients admitted in 2007 through the EDs of nonfederal, acute care hospitals in California. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay and costs. ED crowding was established by the proxy measure of ambulance diversion hours on the day of admission. To control for hospital-level confounders of ambulance diversion, we defined periods of high ED crowding as those days within the top quartile of diversion hours for a specific facility. Hierarchic regression models controlled for demographics, time variables, patient comorbidities, primary diagnosis, and hospital fixed effects. We used bootstrap sampling to estimate excess outcomes attributable to ED crowding. Results We studied 995,379 ED visits resulting in admission to 187 hospitals. Patients who were admitted on days with high ED crowding experienced 5% greater odds of inpatient death (95% confidence interval [CI] 2% to 8%), 0.8% longer hospital length of stay (95% CI 0.5% to 1%), and 1% increased costs per admission (95% CI 0.7% to 2%). Excess outcomes attributable to periods of high ED crowding included 300 inpatient deaths (95% CI 200 to 500 inpatient deaths), 6,200 hospital days (95% CI 2,800 to 8,900 hospital days), and $17 million (95% CI $11 to $23 million) in costs. Conclusion Periods of high ED crowding were associated with increased inpatient mortality and modest increases in length of stay and costs for admitted patients.

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

“…However, HCUP institutional cost-to-charge ratios are commonly used and are widely regarded as acceptable adjustments for estimating the cost of production of care. 34 Fourth, the actual intent to treat of these infants was unknown, which limits the analysis that can be performed to a comparison of the ultimate management strategy or an as-treated comparison. Finally, external generalizability may be limited based on the data source.…”

Emergency Department wait time sharing: Do patients contribute to efficiency?

“…Existent research suggests that ED wait times are related to patient satisfaction, financial performance, and quality outcomes. [5,10,22] However, the relationship between hospital information sharing and ED wait times has not been adequately explored. This research addresses this gap in the literature by answering the following question: "Do ED wait time communication strategies improve patient throughput efficiency?"…”

“…From 2001 to 2006, ED visits increased by 11% while the number of EDs only increased by 4%. [5] Additionally, there is sufficient evidence in the literature to suggest overcrowding is a growing problem for most hospitals across the country. [6] As demand has increased for ED care, hospitals have found it necessary to improve efficiency of services and availability of resources.…”

Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey

“…27,28 These problems hinder the timely treatment of severely injured patients and the effective operation of emergency medical resources, and they also lower the quality of service for inpatients. [29][30][31] Another problem is that most trauma patients are transported to the nearest local hospital as opposed to a trauma centre. 24 Many local emergency medical institutions do not meet even the basic personnel requirements and do not have physician staffing at all times.…”