Abstract
Abstract
Background
During a 6-year period, several process changes were introduced at the emergency department (ED) to decrease crowding, such as the implementation of a general practitioner cooperative (GPC) and additional medical staff during peak hours. In this study, we assessed the effects of these process changes on three crowding measures: patients’ length of stay (LOS), the modified National ED OverCrowding Score (mNEDOCS), and exit block while taking into account changing external circumstances, such as the COVID-19 pandemic and centralization of acute care.
Methods
We determined time points of the various interventions and external circumstances and built an interrupted time-series (ITS) model per outcome measure. We analyzed changes in level and trend before and after the selected time points using ARIMA modeling, to account for autocorrelation in the outcome measures.
Results
Longer patients’ ED LOS was associated with more inpatient admissions and more urgent patients. The mNEDOCS decreased with the integration of the GPC and the expansion of the ED to 34 beds and increased with the closure of a neighboring ED and ICU. More exit blocks occurred when more patients with shortness of breath and more patients > 70 years of age presented to the ED. During the severe influenza wave of 2018–2019, patients’ ED LOS and the number of exit blocks increased.
Conclusions
In the ongoing battle against ED crowding, it is pivotal to understand the effect of interventions, corrected for changing circumstances and patient and visit characteristics. In our ED, interventions which were associated with decreased crowding measures included the expansion of the ED with more beds and the integration of the GPC on the ED.
Publisher
Springer Science and Business Media LLC
Reference38 articles.
1. Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Acad Emer Med. 2011;18(12):1358–70.
2. McKenna PH, Samita M, Viccellio P, Mallon WK, Hernandez C, Morley EJ. Emergency department and hospital crowding: causes, consequences, and cures. Clin Exp Emerg Med. 2019;6(3):189.
3. Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nursing Scholar. 2014;46(2):106–15.
4. Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PloS One. 2018;13(8):e0203316.
5. Javidan AP, Hansen K, Higginson I, Jones P, Petrie D, Bonning J, et al. Report from the Emergency Department Crowding and Access Block Task Force [Internet]. International Federation for Emergency Medicine; 2020. Available from: https://www.ifem.cc/resource-library/.