Expanding emergency department capacity: a multisite study

Abstract

Objectives. The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area.Methods. The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission.Results. Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses.Conclusions. Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered. MODELS OF CAREWhat is known about the topic? Escalating growth in demand for emergency patient services has placed increasing strain on both ambulance and hospital resources. Poor patient outcomes can result from crowded EDs and hospitals. What does this paper add? This paper identifies that following the opening of a 41-bed ED within a health service area, there was an improvement in in-hospital mortality outcomes for those who arrived to the ED via ambulance. Data linkage enhanced our ability to report on and understand the impact on outcomes across several systems (ambulance, ED and hospital admission). This paper provides a foundation for further research regarding emergency services expansion from a geographical area-wide perspective. Easily identifiable predictors of hospital admission for ambulance-arriving patients that may be useful for informing patient flow strategies are highlighted. What are the implications for practitioners? Practitioners need to be aware that patients arriving by ambulance to the ED are more likely to require admission if they are older, triaged to higher acuity, have circulatory or respiratory conditions and have an ED LOS of >4 h. Service planners need to consider the whole system when planning expansion.

“I was worried if I don’t have a broken leg they might not take it seriously”: Experiences of men accessing ambulance services for mental health and/or alcohol and other drug problems

“…As our research indicates, handover can be a time when communication breakdown occurs and patients are left with minimal care and/or needing to repeat their story. Whilst research has indicated that professional's expectations and experiences often are likely to influence quality of handover, results have also indicated that communication, in particular a lack of active listening, has been an issue in handovers . In a qualitative study analysing patients' experiences of handover, communication and bedside manner were also found to impact on patient satisfaction levels during the handover experience, and that patients desired improved communication during their hospital handovers .…”

Exit block in emergency departments: a rapid evidence review

“…In contrast, the third study looked at the effects of expanding ED bed capacity from 81 beds to 122 beds, across three Australian hospitals 23. Over a 2-year period, the authors reported only one outcome to improve: in-hospital mortality.…”

Development and validation of an assessment tool for nursing workload in emergency departments

“…Crilly et al, 2014). In terms of hospitalisation, these findings indicate that the nursing care needs of hospitalised patients were higher in comparing to those of the home-discharged patients.…”

“…In addition, the patient age was an important predictor of nursing time in different settings; the older the patient was, the more time nurses spent with direct care of patients (McGillis Hall, Doran, & Pink, ; O'Brien Pallas, Irvine, Peereboom, & Murray, ). Higher age in ED patients, besides its correlation with JDT, was associated with longer ED‐LOS (Kreindler, Cui, Metge, & Raynard, ) and both age and ED‐LOS predicted hospital admission (Crilly et al, ). In terms of hospitalisation, these findings indicate that the nursing care needs of hospitalised patients were higher in comparing to those of the home‐discharged patients.…”