The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

Blom, Mathias; Jönsson, Fredrik; Landin‐Olsson, Mona; Ivarsson, Kjell

doi:10.1186/1865-1380-7-8

Cited by 30 publications

(38 citation statements)

References 31 publications

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“…Considering our previous results, which showed that the probability for being admitted from the ED is lower at times of high in-hospital occupancy [[17]], the present results suggest that ED physicians make good decisions, also when resources are constrained.…”

Section: Discussionsupporting

confidence: 62%

Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study

et al. 2014

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BackgroundA possible downstream effect of high in-hospital bed occupancy is that patients in the emergency department (ED) who would benefit from in-hospital care are denied admission. The present study aimed at evaluating this hypothesis through investigating associations between in-hospital bed occupancy at the time of presentation in the ED and the probability for unplanned 72-hour (72-h) revisits to the ED among patients discharged at index. A second outcome was unplanned 72-h revisits resulting in admission.MethodsAll visits to the ED of a 420-bed emergency hospital in southern Sweden between 1 January 2011 and 31 December 2012, which did not result in admission, death, or transfer to another hospital were included. Revisiting fractions were computed for in-hospital occupancy intervals <85%, 85% to 90%, 90% to 95%, 95% to 100%, 100% to 105%, and ≥105%. Multivariate models were constructed in an attempt to take confounding factors from, e.g., presenting complaints, age, referral status, and triage priority into account.ResultsIncluded in the study are 81,878 visits. The fraction of unplanned 72-h revisits/unplanned 72-h revisits resulting in admission was 5.8%/1.4% overall, 6.2%/1.4% for occupancy <85%, 6.4%/1.5% for occupancy 85% to 90%, 5.8%/1.4% for occupancy 90% to 95%, 6.0%/1.6% for occupancy 95% to 100%, 5.4%/1.6% for occupancy 100% to 105%, and 4.9%/1.4% for occupancy ≥105%.In the multivariate models, a trend to lower probability of unplanned 72-h revisits was observed at occupancy ≥105% compared to occupancy <95% (OR 0.88, CI 0.76 to 1.01). No significant associations between in-hospital occupancy at index and the probability of making unplanned 72-h revisits resulting in admission were observed.ConclusionsThe lack of associations between in-hospital occupancy and unplanned 72-h revisits does not support the hypothesis that ED patients are inappropriately discharged when in-hospital beds are scarce. The results are reassuring as they indicate that physicians are able to make good decisions, also while resources are constrained.

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Section: Discussionsupporting

confidence: 62%

Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study

et al. 2014

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“…Although evidence is conflicting, 32 hospital crowding has been shown to result in a reduced chance of admission. 33 Furthermore, it is well established in the literature that hospital crowding is a major limiting factor of ED throughput, leading to increasing inpatient boarding. 20,[34][35][36] Therefore, while we did not have access to hospital crowding data, we provided an estimate of hospital crowding by examining the boarding times of patients entering the ED.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Emergency Department Census on the Decision to Admit

Gorski

Batt

Ötleş

et al. 2017

Academic Emergency Medicine

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Objective: We evaluated the effect of emergency department (ED) census on disposition decisions made by ED physicians.Methods: We performed a retrospective analysis using 18 months of all adult patient encounters seen in the main ED at an academic tertiary care center. Patient census information was calculated at the time of physician assignment for each individual patient and included the number of patients in the waiting room (waiting room census) and number of patients being managed by the patient's attending (physician load census). A multiple logistic regression model was created to assess the association between these census variables and the disposition decision, controlling for potential confounders including Emergency Severity Index acuity, patient demographics, arrival hour, arrival mode, and chief complaint.Results: A total of 49,487 patient visits were included in this analysis, of whom 37% were admitted to the hospital. Both census measures were significantly associated with increased chance of admission; the odds ratio (OR) per patient increase for waiting room census was 1.011 (95% confidence interval [CI] = 1.001 to 1.020), and the OR for physician load census was 1.010 (95% CI = 1.002 to 1.019). To put this in practical terms, this translated to a modeled rise from 35.3% to 40.1% when shifting from an empty waiting room and zero patient load to a 12-patient wait and 16-patient load for a given physician. Conclusion:Waiting room census and physician load census at time of physician assignment were positively associated with the likelihood that a patient would be admitted, controlling for potential confounders. Our data suggest that disposition decisions in the ED are influenced not only by objective measures of a patient's disease state, but also by workflow-related concerns. E mergency care is receiving increasing scrutiny as a potential area for cost reductions.1-3 Management of emergency department (ED) costs begins with examining how ED operational characteristics contribute to both patient-level and system-level outcomes. One such characteristic under scrutiny is ED crowding, a phenomenon that can be partially attributed to rising practice intensity 4,5 and inpatient boarding. 6-8 As ED utilization rises, research on the effects of crowding has primarily focused on its influence on patient outcomes, including treatment delays 9-11 and patient mortality.12-15 Less well characterized are organizational responses to increasing operational pressure, such as changes to rates of admission.Highly relevant to the discussion of the cost of emergency care is the growing role of the ED as a "gatekeeper" for inpatient services. 1,16,17 In a 2013 RAND report, hospital admissions rose 4% from 34.7 The authors have no relevant financial information or potential conflicts to disclose. Author contributions: JKG, RJB, and BWP conceived the study; JKG conducted the primary data analysis, with advice and input from RJB and BWP; EO helped with data analysis and offered further methodologic input; JKG pri...

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“…The number of boarding patients gradually increases from Monday to Friday, and then decreases on Friday afternoon. The median (IQR) value was 56 (44-68) for the total number of patients, 35 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) for the number of evaluating patients, and 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) for the number of boarding patients. Therefore, the third quartile, the critical point of overcrowding was 68, 44, and 26, for total, evaluating, and boarding indicators, respectively.…”

Section: Resultsmentioning

confidence: 99%

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Kim

Park

et al. 2020

Preprint

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This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 hours. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 hours from ED arrival time and the last 1 hour before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3,743 (4.3%) returned to the ED within 72 hours. Of the crowding indicators pertaining to total patients, the last 1 hour significantly affected decrease in RV (p=0.0046). Boarding patients were found to increase RV occurrence during the first 1 hour (p=0.0146) and 4 hours (p=0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 hour (p=0.0166) and 4 hours (p=0.0335) and evaluationg patients during the first 1 hour (p=0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

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The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

Cited by 30 publications

References 31 publications

Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study

Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study

The Impact of Emergency Department Census on the Decision to Admit

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

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