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

Abstract

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.

Analyzing Acute Care Surgery Patient Flow in the Emergency Department During COVID-19 Pandemic

“…These restrictions led to a decline in patients who had experienced road accidents and sports-related injuries [3]. On the other hand, it is known that the number of Emergency Medical Services (EMS) arrivals in EDs, due to the pandemic phase evolution, were increased when compared in the initial baseline phase [12].…”

“…The next major step will be implementing new organizational practices as studying important input, throughput, and output factors for ED crowding using existing data from the hospital data warehouse [12]. This will permit a risk stratification guide for severity assessment and triage of suspected or confirmed COVID-19 patients in the ED.…”

Adverse events and preventive measures related to COVID-19 vaccines

“…In the ED, patients with suspected COVID-19 are isolated, and medical personnel are required to wear personal protective equipment (PPE) when being in close contact with the patient. 37,38 The need for patient isolation and the additional amount of time required to wear PPE have caused many difficulties not only for medical personnel but also for patients. 38,39 Moreover, the inadequate bed capacity for isolation has also been an important issue, which increases the burden on the emergency medical system.…”

“…In particular, all types of medical personnel are making intense efforts to prevent the spread of COVID-19 in medical institutions. In the ED, patients with suspected COVID-19 are isolated, and medical personnel are required to wear personal protective equipment (PPE) when being in close contact with the patient [ 37 , 38 ]. The need for patient isolation and the additional amount of time required to wear PPE have caused many difficulties not only for medical personnel but also for patients [ 38 , 39 ].…”

Operationalizing a Pandemic-Ready, Telemedicine-Enabled Drive-Through and Walk-In Coronavirus Disease Garage Care System as an Alternative Care Area: A Novel Approach in Pandemic Management

“… 8 Multiple case studies have described new operational processes for triage, patient placement, diagnostics, and treatment in response to the pandemic. 3 , 9 , 10 Yet, few have proposed optimizing patient flow using telemedicine to enable physical distancing and thus reduce PPE use while interacting with patients. 11 , 12 …”