The Effect of Emergency Department Crowding on Patient Outcomes

Johnson, Kimberly D.; Winkelman, Chris

doi:10.1097/tme.0b013e318207e86a

Cited by 118 publications

(87 citation statements)

References 11 publications

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“…This is especially true in nonuniversity hospitals, where academic freedom is not guaranteed. Delays resulting from ED hallway care leading to patient death have been reported [25][26][27][28][29][30][31][32]. The lay press periodically publishes anecdotes of deaths that occur in ED areas not designated for actual patient care [48,49].…”

Section: Advances In Emergency Medicinementioning

confidence: 99%

“…Medical malpractice actions have occurred as a result of patients receiving care in hallways [9]. There are several studies on the outcome of boarding admitted inpatients in EDs [25][26][27][28][29][30][31][32]. While ED boarding is not synonymous with hallway care, boarded patients in many hospitals spend a significant portion of their total time residing in hallways.…”

Section: Poor Outcomes From Hallway Carementioning

confidence: 99%

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Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

Richards

Linden

Derlet

2014

Advances in Emergency Medicine

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Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care.

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Section: Advances In Emergency Medicinementioning

confidence: 99%

Section: Poor Outcomes From Hallway Carementioning

confidence: 99%

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

Richards

Linden

Derlet

2014

Advances in Emergency Medicine

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“…[2][3][4] Laboratory test results are crucial to diagnostic workup and patient management decisions and thus a potentially important contributor to ED patient flow. Turnaround time (TAT) for laboratory results is frequently used as a key performance indicator of laboratory service performance.…”

mentioning

confidence: 99%

The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross‐classified Random‐effect Modeling Approach

Georgiou

Vecellio

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to examine the relationship between laboratory testing (including test volume and turnaround time [TAT]) and emergency department (ED) length of stay (LOS), using linked patient-level data from four hospitals across 4 years.Methods: This was a retrospective, multisite cohort study of patients presenting to any one of four EDs in New South Wales, Australia, during a 2-month period (August and September) in 2008, 2009, 2010, and 2011. Data from ED information systems were linked to laboratory test data. A cross-classified random-effect modeling approach was applied to identify factors affecting ED LOS, taking into account the correlation between patients' presentations at the same hospital and/or in the same calendar year. Number of test order episodes (tests ordered at one point in time during the ED stay) and TAT (time from laboratory order receipt to result available) were examined.Results: As the number of test order episodes increased, so did the duration of patient ED LOS (p < 0.0001). For every five additional tests ordered per test order episode, the median ED LOS increased by 10 minutes (2.9%, p < 0.0001); each 30-minute increase in TAT was, on average, associated with a 5.1% (17 minutes; p < 0.0001) increase in ED LOS, after adjustment for other factors. Patients presenting to the ED at night (7 p.m. to 7 a.m.) had longer stays than those presenting during the daytime, although the median TATs at nights were shorter than those during the daytime.Conclusions: Laboratory testing has a direct effect on patients' LOS in ED. Laboratory TAT, number of testing episodes, and test volume influence ED LOS. Targeted increases of ED resources and staffing after-hours may also contribute to reductions in ED LOS.ACADEMIC EMERGENCY MEDICINE 2015;22:38-46

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“…For patients attending an emergency department (ED), long waiting times remains a chief complaint for most worldwide. [13,14] The volume of patients requesting care with low to moderate urgency level has led to an increased volume of patients attending the ED and, therefore, an increase in patient wait time. [15] Long wait times can impact patient safety and result in patients leaving the ED before being seen by a doctor.…”

Section: Discussionmentioning

confidence: 99%

Patient willingness to be seen by a physician associate in Ireland

Joyce

Arnett

Hill

et al. 2018

IJH

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Background: The physician associate (PA) role was piloted in Dublin, Ireland between 2015 and 2017. However, the concept of a PA and the acceptance of their role in Ireland had not been explored. Objective: To investigate the willingness of Irish citizens to be seen by a PA based on medical scenarios in a typical clinical setting. Design: A mixed methods study was undertaken. A preference survey, with three medical scenarios, gave participants a choice to be treated by a PA or a doctor, with two time trade-off options offered. Responses were supported with qualitative text. Four hundred people were invited to participate as surrogate patients. Setting and participants: In 2017 a total of 270 respondents took part in the study (67.5%) in two hospitals (one private and one public) in Dublin. The mean age was 60; male (n = 142) and female (n = 128) respondents. Findings: In total, 95% of the respondents chose to see a PA over a doctor based on the scenarios presented and a wait time of 30 minutes. Wait time, trust, competency and the severity or seriousness of the medical condition were categorized into three themes for choosing the PA over the doctor. The "surrogate patient" decisions made by this sample were influenced by knowing that the PA is supervised and can check decisions with his/her supervizing physician. Conclusion: These findings are consistent with studies carried out in other countries where willingness to be seen by a PA is neither age nor gender specific. Patient preference seems to concur around the importance of trust and confidence in the medical provider.

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The Effect of Emergency Department Crowding on Patient Outcomes

Cited by 118 publications

References 11 publications

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross‐classified Random‐effect Modeling Approach

Patient willingness to be seen by a physician associate in Ireland

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