A generic method for evaluating crowding in the emergency department

BMC Emergency Medicine

Research Article

Mogens Erlandsen¹  Hans Kirkegaard²  Andreas Halgreen Eiset²  Anders Brøns Møllekær²  Julie Mackenhauer² 

[1] Department of Public Health, Section of Biostatistics, Aarhus University, Aarhus, Denmark;Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark;

关键词: Crowding;    Emergency department;    ED;    Generic;    Method;    Model;    Queue;    Patient flow;   

DOI  :  10.1186/s12873-016-0083-4

 received in 2015-07-14, accepted in 2016-05-22,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCrowding in the emergency department (ED) has been studied intensively using complicated non-generic methods that may prove difficult to implement in a clinical setting. This study sought to develop a generic method to describe and analyse crowding from measurements readily available in the ED and to test the developed method empirically in a clinical setting.MethodsWe conceptualised a model with ED patient flow divided into separate queues identified by timestamps for predetermined events. With temporal resolution of 30 min, queue lengths were computed as Q(t + 1) = Q(t) + A(t) – D(t), with A(t) = number of arrivals, D(t) = number of departures and t = time interval. Maximum queue lengths for each shift of each day were found and risks of crowding computed. All tests were performed using non-parametric methods. The method was applied in the ED of Aarhus University Hospital, Denmark utilising an open cohort design with prospectively collected data from a one-year observation period.ResultsBy employing the timestamps already assigned to the patients while in the ED, a generic queuing model can be computed from which crowding can be described and analysed in detail. Depending on availability of data, the model can be extended to include several queues increasing the level of information. When applying the method empirically, 41,693 patients were included. The studied ED had a high risk of bed occupancy rising above 100 % during day and evening shift, especially on weekdays. Further, a ‘carry over’ effect was shown between shifts and days.ConclusionsThe presented method offers an easy and generic way to get detailed insight into the dynamics of crowding in an ED.

【 授权许可】

CC BY   
© The Author(s). 2016