Does overcrowding and health insurance type impact patient outcomes in emergency departments?

Araújo, Pedro de; Khraiche, Maroula; Tukan, Andrea

doi:10.1186/2191-1991-3-25

Cited by 13 publications

(5 citation statements)

References 21 publications

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“…They are older, more often male, and their visits tend to result in a higher rate of hospitalization [6]. A tendency toward inappropriate ED use by homeless patients is documented in the literature in association with ED overcrowding resulting in negative prognostic outcomes [7,8].…”

Section: Introductionmentioning

confidence: 99%

The Role of Charity Care and Primary Care Physician Assignment on ED Use in Homeless Patients

Wang

Nejtek

Zieger

et al. 2015

The American Journal of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

The Role of Charity Care and Primary Care Physician Assignment on ED Use in Homeless Patients

Wang

Nejtek

Zieger

et al. 2015

The American Journal of Emergency Medicine

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“…[6][7][8] As ED utilization rises, research on the effects of crowding has primarily focused on its influence on patient outcomes, including treatment delays [9][10][11] and patient mortality. [12][13][14][15] Less well characterized are organizational responses to increasing operational pressure, such as changes to rates of admission.…”

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confidence: 99%

The Impact of Emergency Department Census on the Decision to Admit

Gorski

Batt

Ötleş

et al. 2017

Academic Emergency Medicine

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Objective: We evaluated the effect of emergency department (ED) census on disposition decisions made by ED physicians.Methods: We performed a retrospective analysis using 18 months of all adult patient encounters seen in the main ED at an academic tertiary care center. Patient census information was calculated at the time of physician assignment for each individual patient and included the number of patients in the waiting room (waiting room census) and number of patients being managed by the patient's attending (physician load census). A multiple logistic regression model was created to assess the association between these census variables and the disposition decision, controlling for potential confounders including Emergency Severity Index acuity, patient demographics, arrival hour, arrival mode, and chief complaint.Results: A total of 49,487 patient visits were included in this analysis, of whom 37% were admitted to the hospital. Both census measures were significantly associated with increased chance of admission; the odds ratio (OR) per patient increase for waiting room census was 1.011 (95% confidence interval [CI] = 1.001 to 1.020), and the OR for physician load census was 1.010 (95% CI = 1.002 to 1.019). To put this in practical terms, this translated to a modeled rise from 35.3% to 40.1% when shifting from an empty waiting room and zero patient load to a 12-patient wait and 16-patient load for a given physician. Conclusion:Waiting room census and physician load census at time of physician assignment were positively associated with the likelihood that a patient would be admitted, controlling for potential confounders. Our data suggest that disposition decisions in the ED are influenced not only by objective measures of a patient's disease state, but also by workflow-related concerns. E mergency care is receiving increasing scrutiny as a potential area for cost reductions.1-3 Management of emergency department (ED) costs begins with examining how ED operational characteristics contribute to both patient-level and system-level outcomes. One such characteristic under scrutiny is ED crowding, a phenomenon that can be partially attributed to rising practice intensity 4,5 and inpatient boarding. 6-8 As ED utilization rises, research on the effects of crowding has primarily focused on its influence on patient outcomes, including treatment delays 9-11 and patient mortality.12-15 Less well characterized are organizational responses to increasing operational pressure, such as changes to rates of admission.Highly relevant to the discussion of the cost of emergency care is the growing role of the ED as a "gatekeeper" for inpatient services. 1,16,17 In a 2013 RAND report, hospital admissions rose 4% from 34.7 The authors have no relevant financial information or potential conflicts to disclose. Author contributions: JKG, RJB, and BWP conceived the study; JKG conducted the primary data analysis, with advice and input from RJB and BWP; EO helped with data analysis and offered further methodologic input; JKG pri...

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“…11 Similarly, studies have shown that wait times for uninsured patients can be as high as 33% longer than wait times for patients with insurance. 29 There are several possible explanations for the race- and insurance-related disparities in ED wait times. First, efficient and effective EDs (higher-quality EDs) may be less accessible to vulnerable populations since minority patients tend to reside closer to low-quality hospitals, as defined by mortality rate, relative to their White counterparts.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Wait Time and Treatment of Traumatic Digit Amputation: Do Race and Insurance Matter?

Mahmoudi

Swiatek

Chung

2017

Plastic &Amp; Reconstructive Surgery

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Background Little is known about the association between the quality of trauma care and management of non-fatal injuries. We used emergency department (ED) wait times as a proxy for hospital structure, process, and availability of on-call surgeons with microsurgical skills. We evaluated the association between average hospital ED wait times and likelihood of undergoing digit replantation for patients with traumatic amputation digit injuries. We hypothesized that hospitals with shorter ED wait times were associated with higher odds of replantation. Methods Using the 2007-2012 National Trauma Data Bank, our final sample included 12,126 patients. We used regression modeling to first determine factors that were associated with longer ED wait times among patients with digit amputation injuries. Second, we examined the association between ED wait times for this population at a hospital-level and replantation after all types of digit amputation and after complicated thumb amputation injuries (CTAI) only. Results For patients with simple and CTAIs, and patients with CTAIs only longer ED wait times were associated with lower odds of replantation. Additionally, being minority and having no insurance were associated with longer ED wait times; teaching hospitals were associated with shorter ED wait times; and finally, for patients with CTAIs only there were no association between patients’ minority or insurance status and replantation. Conclusions Variation in ED wait times and its effects on treatment of traumatic digit amputation may reflect maldistribution of hand or plastic surgeons with the required microsurgical skills among trauma centers across the U.S.

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Does overcrowding and health insurance type impact patient outcomes in emergency departments?

Cited by 13 publications

References 21 publications

The Role of Charity Care and Primary Care Physician Assignment on ED Use in Homeless Patients

The Role of Charity Care and Primary Care Physician Assignment on ED Use in Homeless Patients

The Impact of Emergency Department Census on the Decision to Admit

Emergency Department Wait Time and Treatment of Traumatic Digit Amputation: Do Race and Insurance Matter?

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