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Pediatric emergency department overcrowding and impact on patient flow outcomes

Nathan L Timm1, Mona L Ho, Joseph W Luria

  • 1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Nathan.timm@cchmc.org

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|September 30, 2008
PubMed

Insights

Pediatric emergency department (PED) overcrowding, due to patient boarding and high daily census, significantly delays care. Increased patient volume and boarding times worsen length of stay and patient elopements.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Operations
  • Quality Improvement

Background:

  • Overcrowding in pediatric emergency departments (PEDs) is a growing concern impacting care quality.
  • Patient boarding in PEDs and rising emergency department (ED) visits are key contributors to overcrowding.

Purpose of the Study:

  • To analyze the effects of ED boarding time and daily patient census on the timeliness of care within a PED.

Main Methods:

  • Collected data on PED boarding time and daily census from July 2003 to July 2007.
  • Measured outcomes including mean length of stay (LOS), time to triage, time to physician, and patient elopements over 24-hour periods.

Main Results:

  • Exceeding average daily volume (250 patients) by 50 increased LOS by 14.8 min, triage time by 6.6 min, physician time by 18.2 min, and elopements by 3.
  • Each 24-hour increase in ED boarding time raised LOS by 7.6 min, triage time by 0.6 min, physician time by 3 min, and elopements by 0.6.

Conclusions:

  • ED boarding time and daily census are independently associated with longer LOS, triage, and physician times.
  • Both factors also correlate with an increased number of patient elopements from the PED.
Abstract

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