Effects of process changes on emergency department crowding in a changing world: an interrupted time-series analysis

Abstract

Background During a 6-year period, several process changes were introduced at the emergency department (ED) to decrease crowding, such as the implementation of a general practitioner cooperative (GPC) and additional medical staff during peak hours. In this study, we assessed the effects of these process changes on three crowding measures: patients’ length of stay (LOS), the modified National ED OverCrowding Score (mNEDOCS), and exit block while taking into account changing external circumstances, such as the COVID-19 pandemic and centralization of acute care. Methods We determined time points of the various interventions and external circumstances and built an interrupted time-series (ITS) model per outcome measure. We analyzed changes in level and trend before and after the selected time points using ARIMA modeling, to account for autocorrelation in the outcome measures. Results Longer patients’ ED LOS was associated with more inpatient admissions and more urgent patients. The mNEDOCS decreased with the integration of the GPC and the expansion of the ED to 34 beds and increased with the closure of a neighboring ED and ICU. More exit blocks occurred when more patients with shortness of breath and more patients > 70 years of age presented to the ED. During the severe influenza wave of 2018–2019, patients’ ED LOS and the number of exit blocks increased. Conclusions In the ongoing battle against ED crowding, it is pivotal to understand the effect of interventions, corrected for changing circumstances and patient and visit characteristics. In our ED, interventions which were associated with decreased crowding measures included the expansion of the ED with more beds and the integration of the GPC on the ED.

Italy’s Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?

“…This evidence presented in Table 2 is also crucial because the extension of processing times in EDs during the post-pandemic phase has already been shown in the literature, particularly in studies concerning all ED admissions [ 36 , 37 , 38 , 39 , 40 , 41 ]; however, our study is the first to demonstrate that this phenomenon also specifically impacted time-dependent pathologies, such as strokes. We believe that specific analyses are necessary to better understand the potential clinical impact of increased processing time in EDs in terms of disability or other outcomes.…”

Hospital operations management – characterising patients’ process flows in emergency departments

“…In these situations, specific resources may be necessary, as presented by Alexander et al (2020). However, even in services where the initial care is provided by the emergency professional, evaluation by a specialist may be necessary, whether through inhospital consultation, on-call, or teleconsultation (Van Der Linden et al, 2023). Thus, we included Figure 3, which demonstrates the subprocess of medical assessment, characterizing the flow regarding the patient return, specialist involvement and their main activities.…”

“…(2020). However, even in services where the initial care is provided by the emergency professional, evaluation by a specialist may be necessary, whether through in-hospital consultation, on-call, or teleconsultation (Van Der Linden et al. , 2023).…”

Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating reflexive thematic analysis.

“…However this may come at a cost as it redirects the focus of triage staff from their primary role; which is to triage patients 14 . Most recently, virtual care has the potential to divert patients from visiting an ED [15][16][17][18] .…”