Should I stay or should I go? Hospital emergency department waiting times and demand

Sivey, Peter

doi:10.1002/hec.3610

Cited by 19 publications

(26 citation statements)

References 22 publications

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“…This is somewhat inconsistent with Sivey (2018) who finds demand-induced increases in ED waiting times cause larger reductions in the number of patients treated in weekend periods. However, differences in magnitudes between weekday and weekend periods identified in Sivey (2018) were small, and, consistent with our findings, the largest effects were found in an out-of-hours period (6 p.m.-midnight).…”

Section: Discussionsupporting

confidence: 91%

The effects of unexpected changes in demand on the performance of emergency departments

et al. 2020

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Crowding in emergency departments (EDs) is increasing in many health systems. Previous studies of the relationship between crowding and care quality are limited by the use of data from single hospitals, a focus on particular patient groups, a focus on a narrow set of quality measures, and use of crowding measures which induce bias from unobserved hospital and patient characteristics. Using data from 139 hospitals covering all major EDss in England, we measure crowding using quasi-exogenous variation in the volume of EDs attendances and examine its impacts on indicators of performance across the entire EDs care pathway. We exploit variations from expected volume estimated using high-dimensional fixed effects capturing hospital-specific variation in attendances by combinations of month and hour-of-the-week. Unexpected increases in attendance volume result in substantially longer waiting times, lower quantity and complexity of care, more patients choosing to leave without treatment, changes in referral and discharge decisions, but only small increases in reattendances and no increase in mortality. Causal bounds under potential omitted variable bias are narrow and exclude zero for the majority of outcomes. Results suggest that physician and patient responses may largely mitigate the impacts of demand increases on patient outcomes in the short-run. K E Y W O R D S attendance volume, crowding, emergency departments, physician behavior, quality of care 1 | INTRODUCTION Hospital departments providing emergency care are facing unprecedented pressures. In both the United States and the United Kingdom, the last decade has seen substantial increases in attendances at emergency departments (EDs; Trendwatch, 2015). In England, attendances at major EDs grew 24% between 2003/4 and 2018/19 and by 5.8% between September 2018 and September 2019 (NHS England, 2019b). Coupled with supply side pressures such as reductions in the number of inpatient beds and increased rates of patients facing delayed discharges (NHS England, 2017b; The King's This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionsupporting

confidence: 91%

The effects of unexpected changes in demand on the performance of emergency departments

et al. 2020

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“…5 The first measure, 'long overall waits', is the number of attendances to the ED in a week that last more than 4 h, from arrival to the patient being dealt with. Here, 'dealt with' covers discharge alive or dead, inpatient admission or transfer elsewhere [19]. The second measure comprises the number of ED attendances lasting more than 4 h after a decision has been made to admit the patient as an inpatient.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…When more attendances end without treatment, long waits are more frequent. This might reflect a range of scenarios including patients leaving untreated if their expected waiting time is long [19]. EDs also act as a safety net for people suffering a mental health crisis: poor access to specialist mental health services can cause delays [33], and these individuals are more likely to leave EDs without being seen [34].…”

Section: Overall Waits > 4 H (Ed) Trolley Waits > 4 H (Ed) Overall Wamentioning

confidence: 99%

Why are there long waits at English emergency departments?

et al. 2019

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A core performance target for the English National Health Service (NHS) concerns waiting times at Emergency Departments (EDs), with the aim of minimising long waits. We investigate the drivers of long waits. We analyse weekly data for all major EDs in England from April 2011 to March 2016. A Poisson model with ED fixed effects is used to explore the impact on long (> 4 h) waits of variations in demand (population need and patient case-mix) and supply (emergency physicians, introduction of a Minor Injury Unit (MIU), inpatient bed occupancy, delayed discharges and long-term care). We assess overall ED waits and waits on a trolley (gurney) before admission. We also investigate variation in performance among EDs. The rate of long overall waits is higher in EDs serving older patients (4.2%), where a higher proportion of attendees leave without being treated (15.1%), in EDs with a higher death rate (3.3%) and in those located in hospitals with greater bed occupancy (1.5%). These factors are also significantly associated with higher rates of long trolley waits. The introduction of a co-located MIU is significantly and positively associated with long overall waits, but not with trolley waits. There is substantial variation in waits among EDs that cannot be explained by observed demand and supply characteristics. The drivers of long waits are only partially understood but addressing them is likely to require a multi-faceted approach. EDs with high rates of unexplained long waits would repay further investigation to ascertain how they might improve.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“…In hospital emergency departments, the absence of a formal price mechanism to equate the demand for treatment with the available supply means that waiting times act as a rationing device [ 1 ]. The prioritisation of patients is typically based on the severity of symptoms and the urgency of care required, and patients experience waiting times in a ‘queue’ where they must be physically present at the emergency department to receive treatment [ 2 ].…”

mentioning

confidence: 99%

Worth the wait: The impact of government funding on hospital emergency waiting times

McQuestin

Noguchi

2020

Health Policy

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Should I stay or should I go? Hospital emergency department waiting times and demand

Cited by 19 publications

References 22 publications

The effects of unexpected changes in demand on the performance of emergency departments

The effects of unexpected changes in demand on the performance of emergency departments

Why are there long waits at English emergency departments?

Worth the wait: The impact of government funding on hospital emergency waiting times

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