Emergency department crowding and risk of preventable medical errors

Abstract

The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. To accommodate site-to-site differences in available administrative data, ED crowding was measured using one of three previously validated crowding metrics (ED Work Index, ED Workscore, and ED Occupancy). At each site, the continuous measure was placed into site-specific quartiles, and these quartiles then were combined across sites. We found that 46 (8.6%; 95% confidence interval, 6.4-11.3%) of the 533 patients experienced a PME. For those seen during higher levels of ED crowding (quartile 4 vs. quartile 1), the occurrence of PMEs was more than twofold higher, both on unadjusted analysis and adjusting for two potential confounders (diagnosis, site). The association appeared non-linear, with most PMEs occurring at the highest crowding level. We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors.

Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit

“…The resulting documents developed by stakeholders from within the specialty have become the criterion standard for the industry to describe ED operations and are used widely to compare ED performance rates. [6][7][8][9][10][11][12][13][14] These definitions have also been necessary for descriptions of policies created by regulatory bodies, including the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC), and some of the metrics have been endorsed as quality measures by the National Quality Forum. On January 1, 2014, TJC developed and implemented hospital-wide flow program LD.04.02.11 EP 6.…”

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“…2 It is widely known that ED crowding and boarding, as well as ambulance diversion, have an adverse impact on the quality and safety of care, yet these practices continue to pose major problems to the daily delivery of care and to public health. 3,4 They reflect health care issues that extend well beyond the walls of the ED, including hospital crowding, patients' limited access to outpatient care and lack of timely access to on-call specialists, and high rates of uninsurance.…”

Factors Associated With Emergency Department Length of Stay for Patients With Hip Fracture

“…5 Several studies have shown that longer boarding time in the ED increases the morbidity and mortality of patients with hip fracture. [6][7][8][9] In some countries, the length of time in the ED is audited and monitored by the government. In the United Kingdom, for example, the National Health Service audits these times when 5% of the visits result in a wait time of more than 4 hours.…”