Emergency Department Crowding Disparity: a Nationwide Cross-Sectional Study

Chul, Won; Ahn, Ki Ok; Shin, Sang Do; Park, Jeong Ho; Cho, Jin Seong

doi:10.3346/jkms.2016.31.8.1331

Cited by 36 publications

(34 citation statements)

References 38 publications

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“…[17] Although there is no universal consensus on overcrowding measurement, ED occupancy rate is one of the most promising quantifiable methods. [18,19] It is essential that the ED occupancy rate is automatically updated periodically since this data has a time-series nature; our electronic medical record system automatically collects variables necessary for ED occupancy rate calculation at one-hour intervals.…”

Section: Data Collectionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Kim

Bae²,

Sohn

et al. 2020

Preprint

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Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, associations between emergency department crowding and occurrence of both in-hospital cardiac arrest and out-of-hospital cardiac arrest have not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital and out-of-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and out-of-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest and 442 patients had out-of-hospital cardiac arrest. In-hospital cardiac arrest patients compared to out-of-hospital cardiac arrest patients had a significantly higher return of spontaneous circulation rates (16.5% vs. 4.8%; P < .01) and better neurologic outcomes at discharge (cerebral performance category scales 4.7 vs. 4.0; P < .01). Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Out-of-hospital cardiac arrest incidence was negatively correlated with emergency department occupancy (ρ = -0.79, P = .04). Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence, while occupancy rate was negatively correlated with out-of-hospital cardiac arrest incidence.

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Section: Data Collectionmentioning

confidence: 99%

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Kim

Bae²,

Sohn

et al. 2020

Preprint

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“…An obvious difference is the level of services provided by unit. The EDs range from highly specialised units able to manage highly complex cases, to regular EDs in small hospitals with more basic emergency response capacity (Cha, Ahn, Shin, Park, & Cho, ; Wise et al, ; Youd, ). The content of care and the amount of nursing time required by patient and unit may differ accordingly.…”

Section: Methodsmentioning

confidence: 99%

“…Both JDT dependency and age were significantly higher in hospital-admitted versus home-discharged patients (Varndell et al, 2013). In addition, the patient age was an im- Cho, 2016;Wise et al, 2015;Youd, 2015). The content of care and the amount of nursing time required by patient and unit may differ accordingly.…”

Section: Direct Care Time Per Patient In Relationship With the Patienmentioning

confidence: 98%

Development and validation of an assessment tool for nursing workload in emergency departments

Iordache

Elseviers

Cock

et al. 2019

Journal of Clinical Nursing

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Aims To develop the Workload Assessment of Nurses on Emergency (WANE) tool and to test its validity and reliability to measure nursing workload in the emergency departments. Background Ensuring safe nursing staffing in emergency departments is a worldwide concern. There is no valid tool to measure emergency nursing workload in order to determine the needed nurse staffing in the emergency departments. Design A two‐year, cross‐sectional, multicenter study. Methods Workload was operationalised as the time nurses spent with nursing activities, classified into direct and indirect care. A board of experts provided content validity. Construct validity was evaluated by examining the WANE's correlations and group‐discriminations patterns within the network of variables known to determine nursing workload. Reliability was assessed by the tool's ability to yield consistent results across repeated measurements. Reporting of this research adheres to STROBE guidelines. Results Seven emergency departments, including 3,024 patients, were involved in the first year and 18 emergency departments and 7,442 patients in the second year. Direct care time correlated positively and significantly with patient dependency on nursing care, age and length of emergency department stay and discriminated between the categories of dependency on nursing care, age and hospitalisation. Both direct and indirect care time discriminated between the emergency departments according to different patient care profiles and unit characteristics. WANE showed consistent results across measurements. Conclusions Results support the WANE's reliability and validity to measure emergency nursing workload. This tool could be used to determine, on patient and unit, a baseline nurse staffing and the nursing skill mix in the emergency departments. WANE is also an evidence‐based management tool for benchmarking purposes. Relevance to clinical practice The use of an evidence‐based workload tool in making staffing decisions in emergency departments is crucial to ensure safe patient care and prevent work overload in nursing staff.

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“…These three types are RECs, local emergency centers (LECs), and local emergency facilities (LEFs). 11 RECs are the highest EDs within their corresponding regions that receive more government support, e.g., better resources and facilities, than LECs and LEFs. In RECs, it is not only emergency physicians that are present at all times, but also general surgeons, orthopedic surgeons, and neurosurgeons.…”

Section: Study Settingmentioning

confidence: 99%

The influence of age on transfer of pediatric trauma patients after initial transport to hospitals with a higher capacity for general emergency care

et al. 2019

Self Cite

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective:The aim of this study was to investigate factors associated with the decision to transfer, rather than admit, pediatric trauma patients who were initially transported to emergency departments with a high capacity for general emergency care (regional emergency centers, RECs). Methods: In this retrospective analysis of the 2014 emergency medical services (EMS) sample of injured pediatric patients, we included injured patients below 19 years of age who were transported by EMS to an REC. The main exposure variable was age, which was categorized into four groups by 5-year intervals. The primary outcome was the emergency department (ED) disposition of the patients (admission versus transfer). A multivariable logistic regression analysis was conducted to estimate the effect of age group on ED disposition. Results: Data from 2,031 patients were analyzed. The transfer rate was 49.5%. In a univariate analysis, no statistically significant associations were found between severity or age group and ED disposition (19.9% vs. 18.6%, P=0.76; 20.1% vs. 16.8%, P=0.49; respectively). After adjusting for potential covariates, age group had a significant effect on transfer. When compared to 15-19 years old, the younger age groups had higher adjusted odds ratios (aORs) for transfer (0-4 years old, aOR 7.65 [95% CI, 1.24 to 47.38]; 5-9 years old, aOR 14.48 [95% CI, 2.08 to 100.55]; 10-14 years old, aOR 5.03 [95% CI, 10.5 to 26.79]). Conclusion: Younger pediatric patients with moderate to severe trauma are more likely to be transferred to another hospital despite initial transportation to a REC.

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Emergency Department Crowding Disparity: a Nationwide Cross-Sectional Study

Cited by 36 publications

References 38 publications

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

Development and validation of an assessment tool for nursing workload in emergency departments

The influence of age on transfer of pediatric trauma patients after initial transport to hospitals with a higher capacity for general emergency care

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