Overcrowding and Its Association With Patient Outcomes in a Median-Low Volume Emergency Department

BackgroundEmergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals.MethodsOriginal research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase.ResultsOut of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized.ConclusionED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.

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“…• Increase workload [63], delay service provision/decision making and increased ED LOS [53, 54, 56, 60, 61, 63–78]…”

Section: Resultsmentioning

confidence: 99%

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

2019

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“…In support, the report from Rwanda indicated that 63% of respondents perceived increasing complexity and perception of cases as a cause of overcrowding [18]. Besides, different studies reported that overcrowding is a global challenge and may causes crisis in the provision of health care and quality service delivery [6–8, 19, 20]. Further, the consequence of ED crowding is associated with the probability of poor performance and adverse clinical outcomes including mortality [21].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the length of stay in emergency departments in Southern-Ethiopia

et al. 2019

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Objectives This cross-sectional study was conducted on 399 patients at Hawassa University Comprehensive Specialized Hospital from February 15 to March 30/2018 to assess the length of stay (LOS) and its associated factors in emergency departments (EDs). Result About 91.5% patients were stayed in the EDs for greater than 24 h in different reasons. Inadequacy of beds in inpatient wards, overcrowding, absence of different laboratory test profiles and delay in radiological services were showed a significant differences in LOS greater than 24 h when compared to LOS ≤ 24 h in EDs (p < 0.05 for all). In addition, admission beds [adjusted odds ratio: 8.7 (95% CI 3.2–23.2)]; overcrowding [adjusted odds ratio: 3.6 (95% CI 1.6–8.3)]; laboratory test profiles [adjusted odds ratio: 5.1 (95% CI 1.9–14.1)], and radiology services [adjusted odds ratio: 3.7 (95% CI 1.5–9.2)] were significantly and positively associated with LOS greater than 24 h in EDs. Further, a significant proportion of patients were stayed for unnecessary extended length of time in EDs due to different factors. Therefore, the commitment of organization is crucial to provide sufficient number of admission beds, to scale-up laboratory test profiles and to decrease radiology service turn-around time in order to improve LOS in EDs.

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“…These emergency department (ED) facilities are seeing annual increases in patient census that may impact the quality of care [1][2][3]. This increase in ED utilization is coupled with existing issues of overcrowding to exacerbate the challenges of providing a high quality of care and reducing both morbidity and mortality [4][5][6][7][8][9][10][11]. These challenges are complex and multifaceted and are further worsened by return visits to the ED that are avoidable.…”

Section: Introductionmentioning

confidence: 99%

A multicenter mixed-effects model for inference and prediction of 72-h return visits to the emergency department for adult patients with trauma-related diagnoses

et al. 2020

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Objective: Emergency department (ED) return visits within 72 h may be a sign of poor quality of care and entail unnecessary use of healthcare resources. In this study, we compare the performance of two leading statistical and machine learning classification algorithms, and we use the best performing approach to identify novel risk factors of ED return visits. Methods: We analyzed 3.2 million ED encounters with at least one diagnosis under "injury, poisoning and certain other consequences of external causes" and "external causes of morbidity." These encounters included patients 18 years or older from across 128 emergency room facilities in the USA. For each encounter, we calculated the 72-h ED return status and retrieved 57 features from demographics, diagnoses, procedures, and medications administered during the process of administration of medical care. We implemented a mixed-effects model to assess the effects of the covariates while accounting for the hierarchical structure of the data. Additionally, we investigated the predictive accuracy of the extreme gradient boosting tree ensemble approach and compared the performance of the two methods. Results: The mixed-effects model indicates that certain blunt force and non-blunt trauma inflates the risk of a return visit. Notably, patients with trauma to the head and patients with burns and corrosions have elevated risks. This is in addition to 11 other classes of both blunt force and non-blunt force traumas. In addition, prior healthcare resource utilization, patients who have had one or more prior return visits within the last 6 months, prior ED visits, and the number of hospitalizations within the 6 months are associated with increased risk of returning to the ED after discharge. On the one hand, the area under the receiver characteristic curve (AUROC) of the mixed-effects model was 0.710 (0.707, 0.712). On the other hand, the gradient boosting tree ensemble had a lower AUROC of 0.698 CI (0.696, 0.700) on the independent test model.

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Overcrowding and Its Association With Patient Outcomes in a Median-Low Volume Emergency Department

Cited by 18 publications

References 21 publications

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

Challenges, consequences, and lessons for way–outs to emergencies at hospitals: a systematic review study

Factors associated with the length of stay in emergency departments in Southern-Ethiopia

A multicenter mixed-effects model for inference and prediction of 72-h return visits to the emergency department for adult patients with trauma-related diagnoses

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