Emergency department occupancy is useful as a simple real-time measure of crowding

Clouston, R.; Atkinson, Paul; Canales, Donaldo D.; Fraser, Jacqueline; Sohi, Dylan; Lee, Scott; Howlett, Michael

doi:10.1007/s43678-021-00098-8

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…In this study, we were able to use a very precise patient-specific definition for crowding. This has also been the most recommended way of measuring crowding based on earlier studies [ 15 , 16 , 20 ]. The occupancy ratio is a useful metric, since it can be calculated in real-time and thus can be used to assess the level of crowding for clinical purposes, like calling for more staff in time for rush hours.…”

Section: Discussionmentioning

confidence: 99%

Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study

Eidstø,

Ylä-Mattila,

Tuominen

et al. 2023

Intern Emerg Med

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The current evidence suggests that higher levels of crowding in the Emergency Department (ED) have a negative impact on patient outcomes, including mortality. However, only limited data are available about the association between crowding and mortality, especially for patients discharged from the ED. The primary objective of this study was to establish the association between ED crowding and overall 10-day mortality for non-critical patients. The secondary objective was to perform a subgroup analysis of mortality risk separately for both admitted and discharged patients. An observational single-centre retrospective study was conducted in the Tampere University Hospital ED from January 2018 to February 2020. The ED Occupancy Ratio (EDOR) was used to describe the level of crowding and it was calculated both at patient’s arrival and at the maximum point during the stay in the ED. Age, gender, Emergency Medical Service transport, triage acuity, and shift were considered as confounding factors in the analyses. A total of 103,196 ED visits were included. The overall 10-day mortality rate was 1.0% (n = 1022). After controlling for confounding factors, the highest quartile of crowding was identified as an independent risk factor for 10-day mortality. The results were essentially similar whether using the EDOR at arrival (OR 1.31, 95% CI 1.07–1.61, p = 0.009) or the maximum EDOR (OR 1.27, 95% CI 1.04–1.56, p = 0.020). A more precise, mortality-associated threshold of crowding was identified at EDOR 0.9. The subgroup analysis did not yield any statistically significant findings. The risk for 10-day mortality increased among non-critical ED patients treated during the highest EDOR quartile.

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Section: Discussionmentioning

confidence: 99%

Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study

Eidstø,

Ylä-Mattila,

Tuominen

et al. 2023

Intern Emerg Med

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“…The ED, with its complex mission, namely, that of providing an adequate, timely and optimal response to patients who present themselves in an unscheduled manner and addressing clinically critical situations by implementing all the necessary life-saving practices [ 17 ], needs even more rigorous analysis and efficiency. The main problem is that there is no universal standard definition of overcrowding in emergency rooms because there is no single standard measure of hospital performance [ 18 , 19 ]. One of the definitions that seems more complete is that provided by the American College of Emergency Physicians (ACEP) Crowding Resources Task Force, according to which overcrowding can be defined “ a state in which the identified need for emergency services exceeds available resources in the ED.…”

Section: Introductionmentioning

confidence: 99%

“…In a study by Todisco [36], after the introduction of six beds into the emergency room, there was a 10.11% reduction in the NEDOCS. There are also several examples of the application of the NEDOCS index to measure ED crowding [19,37,38].…”

Section: Introductionmentioning

confidence: 99%

A case study to investigate the impact of overcrowding indices in emergency departments

et al. 2022

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Background Emergency department (ED) overcrowding is widespread in hospitals in many countries, causing severe consequences to patient outcomes, staff work and the system, with an overall increase in costs. Therefore, health managers are constantly looking for new preventive and corrective measures to counter this phenomenon. To do this, however, it is necessary to be able to characterize the problem objectively. For this reason, various indices are used in the literature to assess ED crowding. In this work, we explore the use of two of the most widespread crowding indices in an ED of an Italian national hospital, investigate their relationships and discuss their effectiveness. Methods In this study, two of the most widely used indices in the literature, the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Working Index (EDWIN), were analysed to characterize overcrowding in the ED of A.O.R.N. “A. Cardarelli” of Naples, which included 1678 clinical cases. The measurement was taken every 15 minutes for a period of 7 days. Results The results showed consistency in the use of EDWIN and NEDOCS indices as measures of overcrowding, especially in severe overcrowding conditions. Indeed, in the examined case study, both EDWIN and NEDOCS showed very low rates of occurrence of severe overcrowding (2–3%). In contrast, regarding differences in the estimation of busy to overcrowded ED rates, the EDWIN index proved to be less sensitive in distinguishing these variations in the occupancy of the ED. Furthermore, within the target week considered in the study, the results show that, according to both EDWIN and NEDOCS, higher overcrowding rates occurred during the middle week rather than during the weekend. Finally, a low degree of correlation between the two indices was found. Conclusions The effectiveness of both EDWIN and NEDOCS in measuring ED crowding and overcrowding was investigated, and the main differences and relationships in the use of the indices are highlighted. While both indices are useful ED performance metrics, they are not always interchangeable, and their combined use could provide more details in understanding ED dynamics and possibly predicting future critical conditions, thus enhancing ED management.

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“…In many developed countries, EDs are operating at or above capacity, facing the Feral-Pierssens et al BMC Emergency Medicine (2022) 22:71 same phenomenon of "overcrowding" which is often due to downstream congestion with ED patients waiting for a bed on hospital wards and also to the ever-increasing number of ED visits [1][2][3][4]. This phenomenon has significant consequences on the ease of access to ED care; with high rate of patients leaving without being seen (LWBS) by an emergency physician, suboptimal quality of care, higher morbi-mortality and even altered quality of life at work for ED staff [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department

et al. 2022

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Background Emergency departments (EDs) are operating at or above capacity, which has negative consequences on patients in terms of quality of care and morbi-mortality. Redirection strategies for low-acuity ED patients to primary care practices are usually based on subjective eligibility criteria that sometimes necessitate formal medical assessment. Literature investigating the effect of those interventions is equivocal. The aim of the present study was to assess the safety of a redirection process using an electronic clinical support system used by the triage nurse without physician assessment. Methods A single cohort observational study was performed in the ED of a level 1 academic trauma center. All low-acuity patients redirected to nearby clinics through a clinical decision support system (February–August 2017) were included. This system uses different sets of medical prerequisites to identify patients eligible to redirection. Data on safety and patient experience were collected through phone questionnaires on day 2 and 10 after ED visit. The primary endpoint was the rate of redirected patients returning to any ED for an unexpected visit within 48 h. Secondary endpoints were the incidence of 7-day return visit and satisfaction rates. Results A total of 980 redirected low-acuity patients were included over the period: 18 patients (2.8%) returned unexpectedly to an ED within 48 h and 31 patients (4.8%) within 7 days. No hospital admission or death were reported within 7 days following the first ED visit. Among redirected patients, 81% were satisfied with care provided by the clinic staff. Conclusion The implementation of a specific electronic-guided decision support redirection protocol appeared to provide safe deferral to nearby clinics for redirected low-acuity patients. EDs are pivotal elements of the healthcare system pathway and redirection process could represent an interesting tool to improve the care to low-acuity patients.

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Emergency department occupancy is useful as a simple real-time measure of crowding

Cited by 6 publications

References 13 publications

Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study

Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study

A case study to investigate the impact of overcrowding indices in emergency departments

Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department

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