Impact of critical bed status on emergency department patient flow and overcrowding

To compare measurements of emergency department (ED) patient flow during periods of acute ED overcrowding and times of normal patient volume (NPV).

Retrospective ED chart review comparing ED flow for patients treated in a tertiary care teaching hospital during periods of ED overcrowding, defined as critical bed status (CBS), and NPV. All periods of CBS during July 2001 were identified. CBS time intervals were matched with NPV times by month, day of the week, time of day, and number of care providers. All patients registered during these matched time intervals were reviewed. Times were collected for each of the following activities: check-in, bed placement, physician assessment, first intervention, and disposition. Corresponding intervals were calculated in minutes. Triage category was used as a marker of illness severity (1 = most severe, 5 = least severe). Descriptive statistics were performed.

One hundred eighteen patient charts were reviewed: 61 CBS and 57 NPV. There was no statistical difference in illness severity between the two groups. In the cumulative analysis, patients waited significantly longer for an ED bed (30.4 min, p = 0.01) but did not experience significant delays in other intervals. Triage category analysis revealed no significant difference in triage 2 patients. Intermediate-severity patients (triage 3) waited longer in every interval and significantly longer for physician assessment (30.8 min longer, p < 0.05). Low-severity patients (triage 4) waited longer for an ED bed (40 min, p = 0.02) but did not experience other significant delays.

During times of acute overcrowding, the most significant delay occurs awaiting placement in the ED bed.