Hospital overcrowding and care of stroke patients: Irish national audit of stroke.
Humans
Ireland
Crowding
Stroke
/ therapy
Hospital Mortality
Length of Stay
/ statistics & numerical data
Female
Emergency Service, Hospital
/ statistics & numerical data
Male
Thrombolytic Therapy
/ statistics & numerical data
Aged
Medical Audit
Time-to-Treatment
/ statistics & numerical data
Middle Aged
Acute stroke
Emergency Medicine
Epidemiology
Hospital Overcrowding
Outcome
Stroke treatment
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
16 Sep 2024
16 Sep 2024
Historique:
received:
12
09
2023
accepted:
10
09
2024
medline:
17
9
2024
pubmed:
17
9
2024
entrez:
16
9
2024
Statut:
epublish
Résumé
Hospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome. Data on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) 'Trolley Count' database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay. 579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389-27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9-14.0%). Median Quarterly Length of stay was 9 days (8-11 days). Median quarterly door to needle was 65 min (45-80 min). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p = 0.005 t-test) and for Q3 (mean 14542 (sd 4753) p = 0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r = 0.084, p = 0.63), median length of stay r=-0.15, p = 0.37) or thrombolysis rate (r = 0.089 p = 0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p = 0.03). Despite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care.
Identifiants
pubmed: 39285299
doi: 10.1186/s12913-024-11566-z
pii: 10.1186/s12913-024-11566-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1075Informations de copyright
© 2024. The Author(s).
Références
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.
doi: 10.1371/journal.pone.0203316
pubmed: 30161242
pmcid: 6117060
Iacobucci G. Overcrowding and long delays in A&E caused over 4000 deaths last year in England, analysis shows. BMJ. 2021;375:n2835.
doi: 10.1136/bmj.n2835
pubmed: 34794954
Velt KB, Cnossen M, Rood PPM, Steyerberg EW, Polinder S, et al. Emergency department overcrowding: a survey among European neurotrauma centres. Emerg Med J. 2018;35(7):447–8.
doi: 10.1136/emermed-2017-206796
pubmed: 29563151
Rasouli HR, Esfahani AA, Nobakht M, Eskandari M, Mahmoodi S, et al. Outcomes of crowding in Emergency departments; a systematic review. Arch Acad Emerg Med. 2019;7(1):e52.
pubmed: 31602435
pmcid: 6785211
Humphreys H. Overcrowding, understaffing and infection in hospitals. Ir Med J. 2006;99(4):102.
pubmed: 16972578
Conway R, Byrne D, O’Riordan D, Cournane S, Coveney S, et al. Influence of social deprivation, overcrowding and family structure on emergency medical admission rates. QJM. 2016;109(10):675–80.
doi: 10.1093/qjmed/hcw053
pubmed: 27118873
Department of Health and Children. Acute hospital bed capacity: a national review. Department Health Child (Ireland). 2002. https://www.lenus.ie/handle/10147/46287 Accessed 23rd July 2024.
Walsh B, Brick A. ESRI Research Note. Inpatient bed capacity requirements in Ireland in 2023: Evidence on the public acute hospital system. Economic and Social Research Institute (Ireland). 2023. https://www.esri.ie/system/files/publications/RN20230101.pdf Accessed 23rd July 2024.
Sheehan A, O’Sullivan R. Ageing and Public Health-an overview of key statistics in Ireland and Northern Ireland. Institute of Public Health https://publichealth.ie/sites/default/files/2023-02/wp-content/uploads/2020/04/20200416-AGEING-PUBLIC-HEALTH-MAIN.pdf . Accessed 23rd July 2024.
Stevens E, McKevitt C, Emmett E, Wolfe CDA et al. August. The Burden of Stroke in Europe Report. Stroke Alliance for Europe 2020, https://www.safestroke.eu/wp-content/uploads/2020/06/The-Burden-Of-Stroke-In-Europe-Report-Main-Document_ENG_All-references.pdf Accessed 24th 2023.
National Clinical Guideline for Stroke for the UK and Ireland. London: Intercollegiate Stroke Working Party; 2023. www.strokeguideline.org. Accessed 23rd July 2024.
Irish Nurses and Midwives Organisation. INMO Trolley Watch figures. https://www.inmo.ie/News-Campaigns/Trolley-Watch / Accessed24th July 2024.
Irish National Audit of Stroke. Irish National Audit of Stroke National Report. 2021. National Office of Clinical Audit, Ireland 2023. https://www.noca.ie/documents/irish-national-audit-of-stroke-national-report-2013-2021
Bowers F. Why do the HSE and INMO trolley figures differ? https://www.rte.ie/news/analysis-and-comment/2023/0112/1346239-trolley-count/ Accessed August 24th 2023.
National Thrombectomy Service, Ireland. National Thrombectomy Service Annual Report. 2021. Health Service Executive Ireland April 2002. https://www.hse.ie/eng/about/who/cspd/ncps/stroke/resources/national-thrombectomy-service-2021-annual-report.pdf accessed 24th August 2023.
Rodgers H, Price C. Stroke unit care, inpatient rehabilitation and early supported discharge. Clin Med (Lond). 2017: 173–7.
Langhorne P. The stroke Unit Story: where have we been and where are we going? Cerebrovasc Dis. 2021;50:636–43.
doi: 10.1159/000518934
pubmed: 34547746
Mentzoni I, Bogstrand ST, Faiz KW. Emergency department crowding and length of stay before and after an increased catchment area. BMC Health Serv Res. 2019;19(1):506.
doi: 10.1186/s12913-019-4342-4
pubmed: 31331341
pmcid: 6647148
Collins R, Breen C, Bourton-Cassidy L, Coleman S. Early supported discharge for Stroke. Health Service Executive, National Clinical Programme for Stroke. 2022. https://www.hse.ie/eng/about/who/cspd/ncps/stroke/resources/esd-report-2020-and-2021.pdf . Accessed on 1st September 2023.
Medical Council. Medical https:// www.medicalcouncil.ie/news-and-publications/reports/2022-medical-workforce-intelligence-consolidated-report.pdfworkforce Intelligence Consolidated Review 2022. Irish Medical Council 2023. https://www.medicalcouncil.ie/news-and-publications/reports/2022-medical-workforce-intelligence-consolidated-report.pdf Accessed 23rd July 2024.
Aguiar de Sousa D, von Martial R, Abilleira S, Gattringer T, Kobayashi A. Access to and delivery of acute ischaemic stroke treatments: a survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J. 2019;4(1):13–28.
doi: 10.1177/2396987318786023
pubmed: 31165091
Aguiar de Sousa D, Wilkie A, Norrving B, Macey C, Bassetti C et al. Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020. Eur Stroke J. 2023; 23969873231186042.
Irish National Audit of Stroke. Organisational Audit Report 2021. National Office of Clinical Audit, Ireland. 2022. https://www.noca.ie/documents/inas-organisational-audit-report-2021 . Accessed 24th August 2023.