The influence of emergency department crowding on the efficiency of care for acute stroke patients

Tsai, Meng-Chang; Yen, Yung-Lin; Su, Chih-Min; Hung, Chung-Chan; Kung, Chia-Te; Wu, Keng‐Liang; Cheng, Hsien-Hung

doi:10.1093/intqhc/mzw109

Cited by 16 publications

(22 citation statements)

References 21 publications

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“…Effects on patients included delays in being assessed and receiving required care [ 29 , 30 , 76 – 79 , 81 , 83 , 84 , 87 , 90 , 91 , 93 , 94 , 97 , 98 , 103 , 104 ], increased frequency of exposure to error [ 18 ], including medication errors [ 17 ], reduced patient satisfaction [ 102 ], increased inpatient length of stay (IPLOS) [ 82 , 88 , 95 , 99 , 101 ] and poorer outcomes [ 29 , 30 , 75 , 92 , 107 ]; the latter included increased inpatient mortality [ 3 , 80 , 85 , 96 , 99 – 101 ].…”

Section: Resultsmentioning

confidence: 99%

“…Findings were predominantly adverse, with crowding associated with delays in time to receive analgesic [ 79 , 87 , 91 , 93 ] and antibiotic therapy [ 76 , 77 , 89 , 90 , 98 ], as well as delays in patients receiving their usual prescribed or ‘home’ medications [ 83 ]. Two studies reported negative impacts of crowding on timely care for patients with acute stroke [ 94 , 103 ]. One study reported significant delays in triage times, with a significant number of patients not assigned any triage score in times of crowding [ 104 ].…”

Section: Resultsmentioning

confidence: 99%

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Emergency department crowding: A systematic review of causes, consequences and solutions

et al. 2018

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BackgroundEmergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions.AimThe aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding.MethodThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439).ResultsFrom 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions.ConclusionsThe negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Emergency department crowding: A systematic review of causes, consequences and solutions

et al. 2018

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“…[1,2] The imbalance of supply and demand in ED capacity can result in hazardous effects both on physicians and patients, [3] and previous studies have found that overcrowded ED conditions increased physician decision-making time, [4,5] led to more medication errors, [6] decreased quality of care, [7] and increased mortality during hospital stay. [8,9] These potential dangers can be particularly detrimental for patients who needed time-critical interventions to effectively treat emergency conditions such as acute stroke, [4] acute respiratory failure, [10] and septic shock. [11] Cardiac arrest is a critical situation requiring prompt intervention and continues to be a major public health burden.…”

Section: Introductionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Kim

Bae²,

Sohn

et al. 2020

Preprint

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Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, associations between emergency department crowding and occurrence of both in-hospital cardiac arrest and out-of-hospital cardiac arrest have not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital and out-of-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and out-of-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest and 442 patients had out-of-hospital cardiac arrest. In-hospital cardiac arrest patients compared to out-of-hospital cardiac arrest patients had a significantly higher return of spontaneous circulation rates (16.5% vs. 4.8%; P < .01) and better neurologic outcomes at discharge (cerebral performance category scales 4.7 vs. 4.0; P < .01). Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Out-of-hospital cardiac arrest incidence was negatively correlated with emergency department occupancy (ρ = -0.79, P = .04). Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence, while occupancy rate was negatively correlated with out-of-hospital cardiac arrest incidence.

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“…[1,2] The imbalance of supply and demand in ED capacity can result in hazardous effects both on physicians and patients, [3] and previous studies have found that overcrowded ED conditions increased physician decision-making time, [4] led to more medication errors, [5] decreased quality of care, [6] and increased mortality during hospital stay. [7,8] These potential dangers can be particularly detrimental for patients who needed time-critical interventions to effectively treat emergency conditions such as acute stroke, [9] acute respiratory failure, [10] and septic shock. [11] In-hospital cardiac arrest is a critical situation requiring prompt intervention and continues to be a major public health burden.…”

Section: Introductionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Kim

Bae²,

Sohn

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, association between emergency department crowding and occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality. Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest.

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The influence of emergency department crowding on the efficiency of care for acute stroke patients

Abstract: Although ED crowding was not associated with delayed DTN, it predicted delayed DTA and DTCT in thrombolysis-eligible stroke patients. The number of attending physicians affected initial assessment and DTCTs, whereas the number of nurses impacted thrombolytic administration times.

Cited by 16 publications

References 21 publications

Emergency department crowding: A systematic review of causes, consequences and solutions

Emergency department crowding: A systematic review of causes, consequences and solutions

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

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