Pilot study of metropolitan emergency department workload complexity

Area of Science:

• Emergency Medicine
• Healthcare Analytics
• Patient Flow Management

Background:

• Assessing emergency department (ED) patient complexity is crucial for resource allocation and patient care.
• Existing methods for complexity assessment may not fully capture the nuances of patient needs.
• The number of procedures, investigations, or consultations (PICsum) offers a quantifiable measure of patient complexity.

Purpose of the Study:

• To evaluate the utility of the number of procedures, investigations, or consultations (PICsum) as a measure of emergency department (ED) patient complexity.
• To identify patterns in patient complexity distribution within an ED setting.
• To explore the relationship between patient age and ED patient complexity.

Main Methods:

• Retrospective analysis of 12 months of data from an adult metropolitan teaching hospital ED.
• Calculation of the number of procedures, investigations, or consultations (PICsum) for each patient.
• Statistical analysis to determine the distribution of PICsum and its correlation with patient age.

Main Results:

• A bimodal distribution of PICsum was observed, with peaks at 1 and 7.
• Patients requiring a minimum of two procedures, investigations, or consultations (Min2 patients) constituted 59% of all patients and 93% of total PICsum.
• Patient age was highly correlated with both Mean PICsum (r = 0.98) and the proportion of Min2 patients (r = 0.98).

Conclusions:

• An intuitive complexity partition exists at one procedure, one investigation, and one consultation.
• Patient age is a significant correlate of ED patient complexity.
• ED patient age distribution can serve as a proxy for complexity, especially when combined with age-specific complexity data.