Patients presenting at the emergency department with acute abdominal pain are less likely to be admitted to inpatient wards at times of access block: a registry study

Blom, MC; Landin‐Olsson, Mona; Lindsten, M.; Jönsson, Fredrik; Ivarsson, Kjell

doi:10.1186/s13049-015-0158-3

Cited by 9 publications

(14 citation statements)

References 37 publications

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“…The number of boarding patients gradually increases from Monday to Friday, and then decreases on Friday afternoon. The median (IQR) value was 56 (44-68) for the total number of patients, 35 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) for the number of evaluating patients, and 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) for the number of boarding patients. Therefore, the third quartile, the critical point of overcrowding was 68, 44, and 26, for total, evaluating, and boarding indicators, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Accumulation of boarding patients in the ED implies that the ED output is blocked, which is directly affected by the in-hospital bed occupancy [26,27]. If the inpatient occupancy rate is too high and the ED is overcrowded with boarding patients awaiting hospital beds, emergency doctors become more careful when making a decision for additional admissions and decide to transfer some patients to other hospitals or plan discharge and short-term follow-up for patients with relatively mild conditions [28][29][30]. Previous studies have reported that high in-hospital bed occupancy reduced the number of patients admitted through the ED [29,31].…”

Section: Discussionmentioning

confidence: 99%

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Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Kim

Park

et al. 2020

Preprint

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This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 hours. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 hours from ED arrival time and the last 1 hour before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3,743 (4.3%) returned to the ED within 72 hours. Of the crowding indicators pertaining to total patients, the last 1 hour significantly affected decrease in RV (p=0.0046). Boarding patients were found to increase RV occurrence during the first 1 hour (p=0.0146) and 4 hours (p=0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 hour (p=0.0166) and 4 hours (p=0.0335) and evaluationg patients during the first 1 hour (p=0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Kim

Park

et al. 2020

Preprint

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“…Strata were proposed prior to analysis. Since 95 % reflects the median occupancy at the hospital, <95 % was used as a commonsense reference [ 26 ]. Proportions of patients experiencing each outcome were compared across strata using Fisher’s exact test.…”

Section: Methodsmentioning

confidence: 99%

Primary triage nurses do not divert patients away from the emergency department at times of high in-hospital bed occupancy - a retrospective cohort study

et al. 2016

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BackgroundEmergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage. The appropriateness of discharges from primary triage is assessed by 72-h revisits to the ED.MethodsThe study is a retrospective cohort study on administrative data from the ED at a 420-bed hospital in southern Sweden from 2011–2012. In addition to crude comparisons of proportions experiencing each outcome across strata of in-hospital bed occupancy, multivariate models are constructed in order to adjust for age, sex and other factors.ResultsA total of 37,129 visits to primary triage were included in the study. 53.4 % of these were admitted to the ED. Among the cases referred to another level of care, 8.8 % made an unplanned revisit to the ED within 72 h. The permeability of primary triage was not decreased at higher levels of in-hospital bed occupancy. Rather, the permeability was slightly higher at occupancy of 100–105 % compared to <95 % (OR 1.09 95 % CI 1.02–1.16). No significant association between in-hospital bed occupancy and the probability of 72-h revisits was observed.ConclusionsThe absence of a decreased permeability of primary triage at times of high in-hospital bed occupancy is reassuring, as the opposite would have implied that patients might be denied entry not only to the hospital, but also to the ED, when in-hospital beds are scarce.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0102-5) contains supplementary material, which is available to authorized users.

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“…As medicine still is organised around specialties and organ systems, we hope that these more specific results will help build awareness and make valuable additions to previous findings of a more general nature, such as premature hospital discharges, declining mental health in staff and delays in emergency care delivery. [16][17][18][32][33][34][35][36][37][38] Profound variation in the likelihood of direct SU admission from the ED among the study sites (adjusted for bed occupancy), indicate that the capabilities of hospitals to handle bed crises differ. One hypothesis is that this stems from differences in local and regional stroke care traditions and in adherence to national guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…4,[8][9][10] While a link between hospital bed shortages and ED overcrowding is already established, recent publications suggest additional associations with decreased overall hospital admission rates from the ED and premature hospital discharges. [11][12][13][14][15][16][17][18] In an attempt to elaborate the effects of hospital crowding in patients with acute stroke, this study aims at measuring the association between hospital bed occupancy and the likelihood of direct admission to a SU from the ED. A secondary objective is to investigate whether the likelihood of direct SU admission varies across study sites.…”

Section: Introductionmentioning

confidence: 99%

Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study

Darehed

Norrving

Stegmayr

et al. 2017

European Stroke Journal

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Introduction: It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome. Patients and methods: This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011-2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission. Results: A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio ¼ 0.985, 95% confidence interval ¼ 0.978-0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval ¼ 2.6-5.5) for direct admission to a stroke unit versus the reference hospital. Discussion and conclusion: We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

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Patients presenting at the emergency department with acute abdominal pain are less likely to be admitted to inpatient wards at times of access block: a registry study

Cited by 9 publications

References 37 publications

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Primary triage nurses do not divert patients away from the emergency department at times of high in-hospital bed occupancy - a retrospective cohort study

Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study

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