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The effect of emergency department expansion on emergency department overcrowding.
Acad Emerg Med. 2007 Apr; 14(4):338-43.AE

Abstract

OBJECTIVES

To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center.

METHODS

This was a pre-post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five-month pre-expansion period (November 1, 2004, to March 1, 2005) and a five-month postexpansion period (June 1, 2005, to October 31, 2005) were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders.

RESULTS

From pre-expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI = -74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI = -4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI = -4.0 to 3.5). Mean (+/-SD) total LOS increased from 4.6 (+/-1.9) to 5.6(+/-2.3) hours, and mean (+/-SD) admission hold LOS also increased from 3.0 (+/-0.2) to 4.1 (+/-0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre-expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode.

CONCLUSIONS

An increase in ED bed capacity did not affect ambulance diversion. Instead, total and admission hold LOS increased. As a result, ED expansion appears to be an insufficient solution to improve diversion without addressing other bottlenecks in the hospital.

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Authors+Show Affiliations

Han JH
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. jin.h.han@vanderbilt.edu
Zhou C
No affiliation info available
France DJ
No affiliation info available
Zhong S
No affiliation info available
Jones I
No affiliation info available
Storrow AB
No affiliation info available
Aronsky D
No affiliation info available

MeSH

AmbulancesBed OccupancyChi-Square DistributionCrowdingEmergency Service, HospitalHospital Design and ConstructionHumansLength of StayLogistic ModelsRetrospective StudiesStatistics, NonparametricTime Factors

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17400996

Clinical Trial Links

SurgeCon: An Emergency Department Surge Management Platform

Citation

Han, Jin H., et al. "The Effect of Emergency Department Expansion On Emergency Department Overcrowding." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 14, no. 4, 2007, pp. 338-43.
Han JH, Zhou C, France DJ, et al. The effect of emergency department expansion on emergency department overcrowding. Acad Emerg Med. 2007;14(4):338-43.
Han, J. H., Zhou, C., France, D. J., Zhong, S., Jones, I., Storrow, A. B., & Aronsky, D. (2007). The effect of emergency department expansion on emergency department overcrowding. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 14(4), 338-43.
Han JH, et al. The Effect of Emergency Department Expansion On Emergency Department Overcrowding. Acad Emerg Med. 2007;14(4):338-43. PubMed PMID: 17400996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of emergency department expansion on emergency department overcrowding. AU - Han,Jin H, AU - Zhou,Chuan, AU - France,Daniel J, AU - Zhong,Sheng, AU - Jones,Ian, AU - Storrow,Alan B, AU - Aronsky,Dominik, PY - 2007/4/3/pubmed PY - 2007/5/5/medline PY - 2007/4/3/entrez SP - 338 EP - 43 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 14 IS - 4 N2 - OBJECTIVES: To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center. METHODS: This was a pre-post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five-month pre-expansion period (November 1, 2004, to March 1, 2005) and a five-month postexpansion period (June 1, 2005, to October 31, 2005) were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders. RESULTS: From pre-expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI = -74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI = -4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI = -4.0 to 3.5). Mean (+/-SD) total LOS increased from 4.6 (+/-1.9) to 5.6(+/-2.3) hours, and mean (+/-SD) admission hold LOS also increased from 3.0 (+/-0.2) to 4.1 (+/-0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre-expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode. CONCLUSIONS: An increase in ED bed capacity did not affect ambulance diversion. Instead, total and admission hold LOS increased. As a result, ED expansion appears to be an insufficient solution to improve diversion without addressing other bottlenecks in the hospital. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/17400996/The_effect_of_emergency_department_expansion_on_emergency_department_overcrowding_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1069-6563&date=2007&volume=14&issue=4&spage=338 DB - PRIME DP - Unbound Medicine ER -