Impact of emergency department occupancy on waiting times, rates of admission and representation, and length of stay when hospitalised: A data linkage study

Abstract

Objectives: To assess the association between ED occupancy and relevant outcomes including ED waiting times, rates of admission and representation and length of stay when hospitalised. Methods: Retrospective study of all ED presentations by New South Wales (NSW), Australia, residents to 15 NSW public, principal referral or paediatric specialist hospitals between 1 January to 31 December 2015 (N = 935 282). ED data were linked longitudinally (to ED data) and cross-sectionally to hospital admissions data. An ED-system measure of occupancy was assigned to each ED record. The study outcomes were ED waiting time, admission to hospital, 28 day representation, and length of stay (LOS) when admitted. Outcomes were analysed using univariate analyses and multivariable general linear and binary logistic regression models. Results: Increased ED occupancy was associated with increased ED waiting times, particularly at lowbaseline occupancy (e.g. rate ratio = 2.22, 95% confidence interval [CI] [2.10-2.35], for non-urgent triaged patients). However, results were conditional on triage category, such that estimated effects were smaller or not significant in emergency and resuscitation triaged patients (e.g. rate ratio = 1.59, 95% CI [1.52-1.65], for emergency patients). ED occupancy only showed small or no associations with admission to hospital, 28 day representation and LOS when admitted. Conclusions: Higher ED occupancy was associated with increased waiting times conditional on triage category and baseline occupancy. Collectively, the results show that NSW principal referral EDs are robust, and are currently capable of handling variation in occupancy by prioritising treatment for the most urgent patients.

Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018

“…While NSW EDs appear to be currently capable of effectively dealing with rising demand and transient periods of high occupancy, 10,11 there is the possibility that current levels of growth in ED care are unsustainable and might eventually compromise the ability to deliver timely and effective care. Therefore, it is imperative to analyse the changing patterns of ED presentations to better understand the potential drivers behind the rising demand and inform sustainable health care planning 12 .…”

The Feedback Loop Between the Demand for Voluntary Private Insurance and the Burden of Healthcare System: An Explanatory System Dynamics Model of Hong Kong

“…On the left side of this logical chain, existing research reveals the connection between occupancy rate and the wait time in the Accident & Emergency Department (A&E). 52 On the right side, there is research to connect the surgery wait time to the demand for insurance. 53 Assumptions need to be made to bridge these two streams of data in the context of inpatient care.…”

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

“…Other examples in the application of integrated OR methods when dealing with lengthy ED waits are provided in Daldoul et al [168], He et al [109], Lau et al [175], Othman et al [178], Sir et al [122], and Umble and Umble [182]. Other combinations aiming at facing the extended waiting times are simplified in Mazzocato et al [177], Othman and Hammadi [179], Perry [180], and Stephens and Broome [181].…”