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Optimal Measurement Interval for Emergency Department Crowding Estimation Tools.

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Measuring emergency department crowding every 4 hours is effective. This interval balances resource use and early detection, reducing staff burden without compromising patient care outcomes like length of stay or elopement rates.

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Area of Science:

  • Emergency Medicine
  • Healthcare Operations Research
  • Health Services Research

Background:

  • Emergency department (ED) crowding impedes timely patient care.
  • Existing crowding estimation tools lack defined optimal measurement frequencies.
  • Frequent ED crowding assessments can be resource-intensive.

Purpose of the Study:

  • To evaluate if patient outcomes differ based on the measurement interval (1-4 hours) for ED crowding.
  • To compare the impact of different measurement frequencies across four distinct crowding estimation tools.

Main Methods:

  • Analysis of 117,442 patient admissions to an urban ED from July 2015 to June 2016.
  • Generation of 1-, 2-, 3-, and 4-hour crowding scores using NEDOCS, SONET, EDWIN, and ED Occupancy Rate tools.
  • Statistical modeling (accelerated failure time and binomial regression) to assess length of stay and elopement rates.

Main Results:

  • Length of stay and elopement risk showed minimal variation across 1- to 4-hour measurement intervals for all four tools.
  • Time ratios for length of stay ranged from 1.23 to 1.44 across intervals and tools.
  • Risk ratios for elopement ranged from 2.14 to 3.61 across intervals and tools.

Conclusions:

  • A 4-hour measurement interval appears reasonable for assessing ED crowding with the studied tools.
  • Less frequent ED crowding assessments (4-hour interval) can reduce personnel burden.
  • The chosen interval did not significantly impact key patient outcomes like length of stay or elopement.