Hospital Occupancy and its Effect on Emergency Department Evaluation

Area of Science:

• Emergency Medicine
• Health Services Research
• Hospital Operations

Background:

• Understanding factors influencing emergency department (ED) patient flow and hospital admissions is crucial for efficient healthcare delivery.
• High hospital occupancy can strain resources, potentially impacting patient care and disposition decisions within the ED.

Purpose of the Study:

• To investigate the association between daily hospital occupancy and the utilization of diagnostic testing and therapeutic interventions during emergency department evaluations.
• To determine if increased testing or treatment in the ED during high occupancy periods contributes to reduced hospital admissions.

Main Methods:

• Analysis of electronic health records from an urban academic ED (2010-2015) linked with daily hospital occupancy data.
• Multivariable regression models assessed the relationship between hospital occupancy quartiles and outcomes: laboratory testing, advanced imaging, medication administration, and hospitalizations.
• Marginal estimating methods calculated adjusted outcome rates and relative changes across occupancy levels.

Main Results:

• A total of 270,434 ED visits were analyzed.
• Hospital occupancy was not associated with significant differences in laboratory testing, advanced imaging, or medication administration.
• Higher hospital occupancy (third and fourth quartiles) was associated with a decrease in hospitalizations, with a 4.6% absolute reduction in the highest quartile.

Conclusions:

• The study found no evidence that increased testing or treatment in the ED drives reduced admissions during high hospital occupancy.
• Findings suggest that factors beyond ED-level testing and treatment influence admission rates when hospitals are near capacity.
• Further research is needed to identify the mechanisms behind decreased hospitalizations during peak occupancy periods.