Emergency department crowding: factors influencing flow

Area of Science:

• Emergency Medicine
• Healthcare Operations Research
• Patient Flow Management

Background:

• Emergency departments (EDs) face challenges in managing patient flow.
• Key metrics for ED throughput include "door-to-doctor" time and dwell time.
• Factors influencing these times can be intrinsic or extrinsic to the ED.

Purpose of the Study:

• To identify factors influencing "door-to-doctor" time and dwell time in the ED.
• To evaluate intrinsic and extrinsic variables affecting emergency department patient throughput.
• To understand the drivers of patient flow within a hospital setting.

Main Methods:

• Prospective observational study design.
• Observation of adult patients in the ED (Monday-Friday, 8 PM) over three months.
• Statistical analysis using log-rank tests and proportional-hazard regression models to predict "door-to-doctor" and dwell times.

Main Results:

• 1,543 patients were observed, representing 27% of daily volume.
• Median "door-to-doctor" time was 1.8 hours; median dwell time was 5.5 hours.
• Triage category, day of the week, and ED occupancy were the most significant predictors for both metrics.

Conclusions:

• Triage category, ED occupancy, and day of the week are primary contributors to decreased patient flow.
• While inflow issues exist, high ED occupancy may signal outflow obstructions.
• Increased capacity within the ED and hospital may be necessary to improve patient throughput.