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Effect of Emergency Department Crowding on Outcomes of Admitted Patients

Published on Jun 1, 2013in Annals of Emergency Medicine5.209
· DOI :10.1016/j.annemergmed.2012.10.026
Benjamin C. Sun24
Estimated H-index: 24
(OHSU: Oregon Health & Science University),
Renee Y. Hsia33
Estimated H-index: 33
(UCSF: University of California, San Francisco)
+ 5 AuthorsSteven M. Asch64
Estimated H-index: 64
(VA Palo Alto Healthcare System)
Abstract
Study objective: Emergency department (ED) crowding is a prevalent health delivery problem and may adversely affect the outcomes of patients requiring admission. We assess the association of ED crowding with subsequent outcomes in a general population of hospitalized patients. Methods: We performed a retrospective cohort analysis of patients admitted in 2007 through the EDs of nonfederal, acute care hospitals in California. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay and costs. ED crowding was established by the proxy measure of ambulance diversion hours on the day of admission. To control for hospital-level confounders of ambulance diversion, we defined periods of high ED crowding as those days within the top quartile of diversion hours for a specific facility. Hierarchic regression models controlled for demographics, time variables, patient comorbidities, primary diagnosis, and hospital fixed effects. We used bootstrap sampling to estimate excess outcomes attributable to ED crowding. Results: We studied 995,379 ED visits resulting in admission to 187 hospitals. Patients who were admitted on days with high ED crowding experienced 5% greater odds of inpatient death (95% confidence interval [CI] 2% to 8%), 0.8% longer hospital length of stay (95% CI 0.5% to 1%), and 1% increased costs per admission (95% CI 0.7% to 2%). Excess outcomes attributable to periods of high ED crowding included 300 inpatient deaths (95% CI 200 to 500 inpatient deaths), 6,200 hospital days (95% CI 2,800 to 8,900 hospital days), and 17 million (95% CI 1 to $23 million) in costs. Conclusion: Periods of high ED crowding were associated with increased inpatient mortality and modest increases in length of stay and costs for admitted patients. [Ann Emerg Med. 2012;xx:xxx.] Please see page XX for the Editor’s Capsule Summary of this article.
  • References (30)
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References30
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Summary Object Although emergency department (ED) crowding has been shown to be associated with delayed antibiotics treatment in community-acquired pneumonia (CAP) patients, association between ED crowding with mortality has not been investigated. We hypothesized emergency department crowding is associated with 28-day mortality in CAP patients. Methods A retrospective observational study using prospective database was performed on CAP patients who visited a single, urban, tertiary care hospital ...
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#1Gary C. Geelhoed (UWA: University of Western Australia)H-Index: 23
#2Nicholas DeKlerk (Telethon Institute for Child Health Research)H-Index: 59
OBJECTIVE: To assess whether emergency department (ED) overcrowding was reduced after the introduction of the 4-hour rule in Western Australia and whether any changes in overcrowding were associated with significant changes in patient mortality rates. DESIGN, SETTING AND PATIENTS: Quasi-experimental intervention study using dependent pretest and post-test samples. Hospital and patient data were obtained for three tertiary hospitals and three secondary hospitals in Perth, WA, for 2007-08 to 2010-...
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ACADEMIC EMERGENCY MEDICINE 2011; 18:1358–1370 © 2011 by the Society for Academic Emergency Medicine Abstract The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been asso...
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