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Does crowding influence emergency department treatment time and disposition?


ABSTRACT:

Objective

The objective of this study was to determine whether crowding influences treatment times and disposition decisions for emergency department (ED) patients.

Methods

We conducted a retrospective cohort study at 2 hospitals from January 1, 2014, to July 1, 2014. Adult ED visits with dispositions of discharge, admission, or transfer were included. Treatment times were modeled by linear regression with log-transformation; disposition decisions (admission or transfer vs discharge) were modeled by logistic regression. Both models adjusted for chief complaint, Emergency Severity Index (ESI), and 4 crowding metrics in quartiles: waiting count, treatment count, boarding count, and National Emergency Department Overcrowding Scale.

Results

We included 21,382 visits at site A (12.9% excluded) and 29,193 at site B (15.0% excluded). Respective quartiles of treatment count increased treatment times by 7.1%, 10.5%, and 13.3% at site A (P < 0.001) and by 4.0%, 6.5%, and 10.2% at site B (P < 0.001). The fourth quartile of treatment count increased estimates of treatment time for patients with chest pain and ESI level 2 from 2.5 to 2.9 hours at site A (20 minutes) and from 3.0 to 3.3 hours at site B (18 minutes). Treatment times decreased with quartiles of waiting count by 5.6%, 7.2%, and 7.3% at site B (P < 0.001). Odds of admission or transfer increased with quartiles of waiting count by 8.7%, 9.6%, and 20.3% at site A (P = 0.011) and for the third (11.7%) and fourth quartiles (27.3%) at site B (P < 0.001).

Conclusions

Local crowding influenced ED treatment times and disposition decisions at 2 hospitals after adjusting for chief complaint and ESI.

SUBMITTER: Hoot NR 

PROVIDER: S-EPMC7819268 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Does crowding influence emergency department treatment time and disposition?

Hoot Nathan R NR   Banuelos Rosa C RC   Chathampally Yashwant Y   Robinson David J DJ   Voronin Benjamin W BW   Chambers Kimberly A KA  

Journal of the American College of Emergency Physicians open 20201203 1


<h4>Objective</h4>The objective of this study was to determine whether crowding influences treatment times and disposition decisions for emergency department (ED) patients.<h4>Methods</h4>We conducted a retrospective cohort study at 2 hospitals from January 1, 2014, to July 1, 2014. Adult ED visits with dispositions of discharge, admission, or transfer were included. Treatment times were modeled by linear regression with log-transformation; disposition decisions (admission or transfer vs dischar  ...[more]

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