The Emergency Department Occupancy Rate: A Simple Measure of Emergency Department Crowding?

McCarthy, Melissa L.; Aronsky, Dominik; Jones, Ian D.; Miner, James R.; Band, Roger A.; Baren, Jill M.; Desmond, Jeffrey S.; Baumlin, Kevin M.; Ding, Ru; Shesser, Robert

doi:10.1016/j.annemergmed.2007.09.003

Cited by 161 publications

(164 citation statements)

References 36 publications

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“…Recent research shows that ED occupancy predicts overcrowding as well as these workload measures [Hoot et al 2007] and correlates well with the staff's perception of overcrowding [McCarthy et al 2008]. …”

Section: Threshold Policiesmentioning

confidence: 99%

Centralized vs. Decentralized Ambulance Diversion: A Network Perspective

Deo

Gurvich²

2011

SSRN Journal

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Section: Threshold Policiesmentioning

confidence: 99%

Centralized vs. Decentralized Ambulance Diversion: A Network Perspective

Deo

Gurvich²

2011

SSRN Journal

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“…15 The ED occupancy rate (EDOR) was calculated as the total number of ED patients, regardless of ED location (including the waiting room and hallway locations), divided by the number of licensed ED beds. 16 Although we recognize the potential limitations with all quantitative measures of ED crowding, 17 we selected EDOR and patient occupancy counts based on their previous use in the stroke literature and their face validity as instantaneous measures of ED demand-capacity mismatch.…”

Section: Study Design and Settingmentioning

confidence: 99%

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

Reznek

Murray

Youngren

et al. 2017

Stroke

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Background and Purpose-National guidelines call for door-to-imaging time (DIT) within 25 minutes for suspected acute stroke patients. Studies examining factors that affect DIT have focused primarily on stroke-specific care processes and patient-specific factors. We hypothesized that emergency department (ED) crowding is associated with longer DIT. Methods-We conducted a retrospective investigation of 1 year of consecutive patients in our prospective Code Stroke registry, which included all ED stroke team activations. The registry and electronic health records were abstracted for 27 potential predictors of DIT, including patient, stroke care process, and ED operational factors. We fit a multivariate logistic regression model and calculated odds ratios and 95% confidence intervals. Second, we constructed a random forest recursive partitioning model to cross-validate our findings and explore the proportional importance of each category of predictor. Our primary outcome was the binary variable of DIT within the 25-minute goal. Results-A total of 463 patients met inclusion criteria. In the regression model, ED occupancy rate emerged as a predictor of DIT, with odds ratio of 0.83 (95% confidence interval, 0.75-0.91) of DIT within 25 minutes per 10% absolute increase in ED occupancy rate. The secondary analysis estimated that ED operational factors accounted for nearly 14% of the algorithm's prediction of DIT. Conclusions-ED crowding is associated with reduced odds of meeting DIT goals for acute stroke. In addition to improving stroke-specific processes of care, efforts to reduce ED overcrowding should be considered central to optimizing the timeliness of acute stroke care.

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“…These observations have been confirmed recently in studies by other groups. 26 These crowding elements were assigned as a patient-level exposure at the time of ED triage. In EMTrac, all elements of individual patient care timing, including patient triage time, room arrival time, physician order times (including medication, radiography, and bed request), and discharge time, are automatically time stamped.…”

Section: Survey Content and Administrationmentioning

confidence: 99%

The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients

Pines

Iyer

Disbot

et al. 2008

Academic Emergency Medicine

279

192

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Objectives: The objective was to study the association between factors related to emergency department (ED) crowding and patient satisfaction. Methods:The authors performed a retrospective cohort study of all patients admitted through the ED who completed Press-Ganey patient satisfaction surveys over a 2-year period at a single academic center. Ordinal and binary logistic regression was used to study the association between validated ED crowding factors (such as hallway placement, waiting times, and boarding times) and patient satisfaction with both ED care and assessment of satisfaction with the overall hospitalization.Results: A total of 1,501 hospitalizations for 1,469 patients were studied. ED hallway use was broadly predictive of a lower likelihood of recommending the ED to others, lower overall ED satisfaction, and lower overall satisfaction with the hospitalization (p < 0.05). Prolonged ED boarding times and prolonged treatment times were also predictive of lower ED satisfaction and lower satisfaction with the overall hospitalization (p < 0.05). Measures of ED crowding and ED waiting times predicted ED satisfaction (p < 0.05), but were not predictive of satisfaction with the overall hospitalization.Conclusions: A poor ED service experience as measured by ED hallway use and prolonged boarding time after admission are adversely associated with ED satisfaction and predict lower satisfaction with the entire hospitalization. Efforts to decrease ED boarding and crowding might improve patient satisfaction. ACADEMIC EMERGENCY MEDICINE 2008; 15:825-831 ª 2008 by the Society for Academic Emergency MedicineKeywords: emergency department crowding, overcrowding, patient satisfaction, hallway, boarding, crowding P atient satisfaction data are used by emergency department (ED) administrators to track aggregate data over time, study interventions, assess individual physician performance, and construct financial incentive plans.1,2 A recent study identified six elements of emergency care associated with poor satisfaction: 1) not receiving help when needed, 2) a poorly explained problem, 3) not being told about waiting times, 4) not being told when to resume normal activities, 5) not having test results explained, and 6) not understanding when to return to the ED.3,4 While many elements of satisfaction are under provider control, many elements of ED care are difficult for an individual provider to improve, such as waiting time, boarding time, use of hallway treatment space, and overall levels of ED crowding that might reduce staff availability and impede ancillary services such as radiology and laboratory results. 5-11Despite the challenges of obtaining reliable and valid data, measurement of patient satisfaction is recognized by providers and regulators as vital to quality assurance and improvement.12,13 Satisfied patients are more likely to be compliant with their medications, return for continuing medical care, and communicate more effectively with their physicians.14-16 Patient satisfaction itself has been prop...

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The Emergency Department Occupancy Rate: A Simple Measure of Emergency Department Crowding?

Cited by 161 publications

References 36 publications

Centralized vs. Decentralized Ambulance Diversion: A Network Perspective

Centralized vs. Decentralized Ambulance Diversion: A Network Perspective

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients

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