ED crowding and the use of nontraditional beds

Area of Science:

• Emergency Medicine
• Healthcare Operations Research

Background:

• Emergency departments (EDs) often use nontraditional settings like hallways or conference rooms to manage patient crowding.
• The effect of these practices on ED patient evaluation time is not well understood.

Purpose of the Study:

• To investigate the relationship between ED bed assignment (traditional, hallway, or conference room) and mean ED evaluation time.
• To analyze how chief complaint categories influence this relationship.

Main Methods:

• A historical cohort study of 15,073 adult ED visits was conducted.
• Multiple linear regression and marginal prediction were used to compare mean ED evaluation times across different bed types.
• Chief complaints were categorized into five main groups.

Main Results:

• Assignment to hallway beds increased mean ED evaluation time by 13.3 minutes compared to traditional beds.
• Assignment to conference room beds increased mean ED evaluation time by 10.9 minutes compared to traditional beds.
• The impact of bed assignment on evaluation time varied by chief complaint category.

Conclusions:

• The use of nontraditional ED beds is associated with a small increase in mean patient evaluation time.
• This increase can potentially be minimized by strategically assigning patients with specific chief complaints to nontraditional beds.
• Nontraditional beds may still play a role in improving ED throughput during periods of high patient volume.