Does crowding influence emergency department treatment time and disposition?

Area of Science:

• Emergency Medicine
• Healthcare Operations Research
• Health Services Research

Background:

• Emergency department (ED) crowding is a complex issue affecting patient flow and care quality.
• Understanding the relationship between crowding metrics and patient outcomes is crucial for optimizing ED operations.

Purpose of the Study:

• To investigate the influence of specific crowding metrics on emergency department patient treatment times.
• To determine the impact of crowding on disposition decisions (discharge, admission, or transfer) for ED patients.

Main Methods:

• A retrospective cohort study was conducted involving adult ED visits at two hospitals.
• Treatment times and disposition decisions were analyzed using regression models, adjusting for chief complaint, Emergency Severity Index (ESI), and four crowding metrics.
• Crowding metrics included waiting count, treatment count, boarding count, and the National Emergency Department Overcrowding Scale.

Main Results:

• Increased treatment counts were associated with significantly longer treatment times at both study sites.
• Higher waiting counts correlated with decreased treatment times at one site but increased odds of admission or transfer at both sites.
• Specific patient groups, like those with chest pain and ESI level 2, experienced substantial delays during peak crowding.

Conclusions:

• Local crowding metrics demonstrably influence emergency department treatment durations.
• Crowding also plays a significant role in determining patient disposition from the emergency department.
• These findings highlight the need for targeted interventions to mitigate the adverse effects of ED crowding.