Influence of Weekday and Seasonal Trends on Urgency and In-hospital Mortality of Emergency Department Patients

Abstract

BackgroundGiven the scarcity of resources, the increasing use of emergency departments (ED) represents a major challenge for the care of emergency patients. Current health policy interventions focus on restructuring emergency care with the help of patient re-direction into outpatient treatment structures. A precise analysis of ED utilization, taking into account treatment urgency, is essential for demand-oriented adjustments of emergency care structures.MethodsTemporal and seasonal trends in the use of EDs were investigated, considering treatment urgency and hospital mortality. Secondary data of 287,119 ED visits between 2015 and 2017 of the two EDs of Charité Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow Klinikum were analyzed.ResultEDs were used significantly more frequently on weekends than on weekdays (Mdn = 290 vs. 245 visits/day; p < 0.001). The proportion of less urgent, outpatient emergency visits on weekends was above average. Holiday periods were characterized by at least 6, and at most 176 additional ED visits. In a comparison of different holidays, most ED visits were observed at New Year (+68% above average). In addition, a significant increase in in-hospital mortality on holidays was evident among inpatients admitted to hospital via the ED (3.0 vs. 3.2%; p < 0.001), with New Year's Day being particularly striking (5.4%).ConclusionThese results suggest that, in particular, the resource planning of outpatient emergency treatment capacities on weekends and holidays should be adapted to the increased volume of non-urgent visits in EDs. Nevertheless, treatment capacities for the care of urgent, inpatient emergencies should not be disregarded and further research projects are necessary to investigate the causes of increased mortality during holiday periods.

Forecasting Hospital Visits Due to Influenza Based on Emergency Department Visits for Fever: A Feasibility Study on Emergency Department-Based Syndromic Surveillance

“…It has been well established that the number of patients visiting the ED is higher during the weekend, and the proportion of less urgent or outpatient emergency visits is also higher during the weekend [19]. In addition to previous results, our dataset also identified an increased number of ED visits during the weekend (see Appendix A).…”

“…When the correlation of these two data was measured, the daily seven-day moving average of ED visits with fever and patients with influenza showed a moderate correlation with a Pearson's correlation coefficient of 0.73 (p-value < 0.001, Figure 2). It has been well established that the number of patients visiting the ED is higher during the weekend, and the proportion of less urgent or outpatient emergency visits is also higher during the weekend [19]. In addition to previous results, our dataset also identified an increased number of ED visits during the weekend (see Appendix A).…”

Koma unklarer Genese – Der Weg zur Diagnose

“…Infolgedessen ist das Koma unklarer Genese kein seltenes Problem. Die betroffenen Patienten sind im Median 65 Jahre alt, was im Vergleich zum Durchschnittsalter aller Patienten in der Notaufnahme (40 Jahre) deutlich höher liegt [8].…”

Forecasting emergency department arrivals using INGARCH models

“…Patient arrival in EDs is uneven over time. Distribution over the days of the week is not uniform and, although there are variations from one centre to another, some days account for a clearly higher number of visits, e.g., Mondays (see [ 9 , 20 ]. Likewise, distribution throughout the year is not uniform.…”

“…Likewise, distribution throughout the year is not uniform. Demand for care varied in relation to holiday periods (demographic movements), respiratory virus epidemics, climatic and atmospheric changes and social events [ 20 ]. Handling surges, which is the main challenge to ensuring efficient ED management and functioning [ 7 , 16 , 21 , 26 ], is closely related to appropriate timing of treatment.…”