Evaluating the impact of emergency department crowding on disposition patterns and outcomes of discharged patients.
Disposition decision-making
Emergency department crowding
Outcomes
Journal
International journal of emergency medicine
ISSN: 1865-1372
Titre abrégé: Int J Emerg Med
Pays: England
ID NLM: 101469435
Informations de publication
Date de publication:
30 Jan 2019
30 Jan 2019
Historique:
received:
09
07
2018
accepted:
21
01
2019
entrez:
11
6
2019
pubmed:
11
6
2019
medline:
11
6
2019
Statut:
epublish
Résumé
Crowding is a major challenge faced by EDs and is associated with poor outcomes. Determine the effect of high ED occupancy on disposition decisions, return ED visits, and hospitalizations. We conducted a retrospective analysis of electronic health records of patients evaluated at an adult, urban, and academic ED over 20 months between the years 2012 and 2014. Using a logistic regression model predicting admission, we obtained estimates of the effect of high occupancy on admission disposition, adjusted for key covariates. We then stratified the analysis based on the presence or absence of high boarder patient counts. Disposition decisions during a high occupancy hour decreased the odds of admission (OR = 0.93, 95% CI: [0.89, 0.98]). Among those who were not admitted, high occupancy was not associated with increased odds of return in the combined (OR = 0.94, 95% CI: [0.87, 1.02]), with-boarders (OR = 0.96, 95% CI: [0.86, 1.09]), and no-boarders samples (OR = 0.93, 95% CI: [0.83, 1.04]). Among those who were not admitted and who did return within 14 days, disposition during a high occupancy hour on the initial ED visit was not associated with a significant increased odds of hospitalization in the combined (OR = 1.04, 95% CI: [0.87, 1.24]), the with-boarders (OR = 1.12, 95% CI: [0.87, 1.44]), and the no-boarders samples (OR = 0.98, 95% CI: [0.77, 1.24]). ED crowding was associated with reduced likelihood of hospitalization without increased likelihood of 2-week return ED visit or hospitalization. Furthermore, high occupancy disposition hours with high boarder patient counts were associated with decreased likelihood of hospitalization.
Sections du résumé
BACKGROUND
BACKGROUND
Crowding is a major challenge faced by EDs and is associated with poor outcomes.
OBJECTIVES
OBJECTIVE
Determine the effect of high ED occupancy on disposition decisions, return ED visits, and hospitalizations.
METHODS
METHODS
We conducted a retrospective analysis of electronic health records of patients evaluated at an adult, urban, and academic ED over 20 months between the years 2012 and 2014. Using a logistic regression model predicting admission, we obtained estimates of the effect of high occupancy on admission disposition, adjusted for key covariates. We then stratified the analysis based on the presence or absence of high boarder patient counts.
RESULTS
RESULTS
Disposition decisions during a high occupancy hour decreased the odds of admission (OR = 0.93, 95% CI: [0.89, 0.98]). Among those who were not admitted, high occupancy was not associated with increased odds of return in the combined (OR = 0.94, 95% CI: [0.87, 1.02]), with-boarders (OR = 0.96, 95% CI: [0.86, 1.09]), and no-boarders samples (OR = 0.93, 95% CI: [0.83, 1.04]). Among those who were not admitted and who did return within 14 days, disposition during a high occupancy hour on the initial ED visit was not associated with a significant increased odds of hospitalization in the combined (OR = 1.04, 95% CI: [0.87, 1.24]), the with-boarders (OR = 1.12, 95% CI: [0.87, 1.44]), and the no-boarders samples (OR = 0.98, 95% CI: [0.77, 1.24]).
CONCLUSION
CONCLUSIONS
ED crowding was associated with reduced likelihood of hospitalization without increased likelihood of 2-week return ED visit or hospitalization. Furthermore, high occupancy disposition hours with high boarder patient counts were associated with decreased likelihood of hospitalization.
Identifiants
pubmed: 31179922
doi: 10.1186/s12245-019-0223-1
pii: 10.1186/s12245-019-0223-1
pmc: PMC6354348
doi:
Types de publication
Journal Article
Langues
eng
Pagination
4Subventions
Organisme : National Institute on Aging
ID : 5R21AG043739-03
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