Evaluating the impact of emergency department crowding on disposition patterns and outcomes of discharged patients

International Journal of Emergency Medicine

article

Abir, Mahshid¹  Goldstick, Jason E.¹  Malsberger, Rosalie³  Williams, Andrew⁴  Bauhoff, Sebastian⁵  Parekh, Vikas I.⁶  Kronick, Steven⁷  Desmond, Jeffrey S.⁷ 

[1] Department of Emergency Medicine, Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan;RAND Corporation;Mathematica Policy Research;Hackensack University Medical Center;Department of Global Health and Population, Harvard T.H. Chan School of Public Health;Department of Internal Medicine, University of Michigan;Department of Emergency Medicine, University of Michigan

关键词: Emergency department crowding;    Outcomes;    Disposition decision-making;   

DOI  :  10.1186/s12245-019-0223-1

学科分类：工业工程学

来源: Springer

【 摘 要 】

Crowding is a major challenge faced by EDs and is associated with poor outcomes. Determine the effect of high ED occupancy on disposition decisions, return ED visits, and hospitalizations. We conducted a retrospective analysis of electronic health records of patients evaluated at an adult, urban, and academic ED over 20 months between the years 2012 and 2014. Using a logistic regression model predicting admission, we obtained estimates of the effect of high occupancy on admission disposition, adjusted for key covariates. We then stratified the analysis based on the presence or absence of high boarder patient counts. Disposition decisions during a high occupancy hour decreased the odds of admission (OR = 0.93, 95% CI: [0.89, 0.98]). Among those who were not admitted, high occupancy was not associated with increased odds of return in the combined (OR = 0.94, 95% CI: [0.87, 1.02]), with-boarders (OR = 0.96, 95% CI: [0.86, 1.09]), and no-boarders samples (OR = 0.93, 95% CI: [0.83, 1.04]). Among those who were not admitted and who did return within 14 days, disposition during a high occupancy hour on the initial ED visit was not associated with a significant increased odds of hospitalization in the combined (OR = 1.04, 95% CI: [0.87, 1.24]), the with-boarders (OR = 1.12, 95% CI: [0.87, 1.44]), and the no-boarders samples (OR = 0.98, 95% CI: [0.77, 1.24]). ED crowding was associated with reduced likelihood of hospitalization without increased likelihood of 2-week return ED visit or hospitalization. Furthermore, high occupancy disposition hours with high boarder patient counts were associated with decreased likelihood of hospitalization.

【 授权许可】

CC BY|CC0