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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Emergency department crowding affects triage processes.

M Christien van der Linden1, Barbara E A M Meester2, Naomi van der Linden3

  • 1Clinical Epidemiologist, Emergency Department, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, The Netherlands.

International Emergency Nursing
|March 14, 2016
PubMed
Summary

Emergency department (ED) crowding significantly delays triage times and increases patient length of stay (LOS). However, crowding did not affect the decision to redirect patients to a general practitioner cooperative (GPC).

Keywords:
Emergency department crowdingEmergency service, hospitalOvercrowdingTriage

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Area of Science:

  • Emergency Medicine
  • Healthcare Operations
  • Patient Flow Management

Background:

  • Emergency department (ED) crowding occurs when demand for emergency care exceeds available resources.
  • Crowding can potentially disrupt critical patient care processes, including triage.

Purpose of the Study:

  • To assess the impact of ED crowding on the patient triage process.
  • To analyze the relationship between ED occupancy and triage efficiency, patient outcomes, and destination.

Main Methods:

  • A retrospective analysis of 49,539 patient records over one year.
  • Data included occupancy ratios, length of stay (LOS), time to triage, triage scores, and triage destination.
  • Statistical analyses included descriptive statistics and regression analyses.

Main Results:

  • During crowding, target triage times were missed more frequently (49.7% vs. 24.9%) and more patients were not triaged (2.2% vs. 1.6%).
  • Higher ED occupancy correlated with longer triage waiting times and increased LOS (P < 0.001).
  • Crowding did not influence redirection rates to the general practitioner cooperative (GPC) (P = 0.122), though experienced triage nurses were more likely to redirect patients (P < 0.001).

Conclusions:

  • ED crowding negatively impacts the triage process, resulting in extended waiting times for triage and longer ED LOS.
  • The level of crowding did not influence the decision to redirect patients to the GPC.
  • Further research may explore factors influencing triage destination decisions independently of crowding levels.