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Is emergency department crowding associated with increased "bounceback" admissions?
Renee Y Hsia1, Steven M Asch, Robert E Weiss
1*Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco †VA Palo Alto Health Care System, Center for Healthcare Evaluation, Menlo Park ‡Department of Biostatistics, UCLA Fielding School of Public Health §Department of Medicine ∥Department of Medicine, Division of Geriatrics, University of California, Los Angeles, Los Angeles, CA ¶Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
Emergency department (ED) crowding, measured by ambulance diversion, did not increase the likelihood of patients returning for hospital admission within 7 days. This suggests bounceback admissions may not reflect care quality issues due to ED crowding.
Area of Science:
- Health Services Research
- Emergency Medicine
- Health Outcomes
Background:
- Emergency department (ED) crowding is associated with decreased care quality and increased mortality.
- Concerns exist that ED crowding may lead to higher rates of subsequent inpatient admissions, impacting hospital performance measures.
- The relationship between ED crowding and
- bounceback
- admissions requires further investigation.
Purpose of the Study:
- To investigate the association between emergency department (ED) crowding during an index visit and subsequent bounceback admissions within 7 days.
- To determine if patients presenting to the ED on crowded days are more likely to be readmitted.
Main Methods:
- Utilized comprehensive statewide ED and inpatient discharge data from California (2007).
- Identified index ED visits and bounceback admissions within 7 days.
- Employed ambulance diversion data to define crowded ED days and hierarchical logistic regression to analyze the association with bounceback admissions.
Main Results:
- Analyzed over 3.3 million index ED visits across 202 hospitals.
- Found no statistically significant association between ED crowding (measured by ambulance diversion) and bounceback admissions.
- Both discrete (high/low) and continuous models showed no increased odds of readmission due to crowding.
Conclusions:
- Emergency department crowding, as indicated by ambulance diversion, is not associated with an increased likelihood of hospitalization within 7 days of discharge.
- Bounceback admissions may not be a reliable indicator of delayed or compromised care quality resulting from ED crowding.
- Further research is needed to identify appropriate metrics for assessing care quality during periods of ED overcrowding.
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