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Temporal trends in emergency department volumes and crowding metrics in a western Canadian province: a population-based, administrative data study.
BMC Health Serv Res. 2020 Apr 26; 20(1):356.BH

Abstract

BACKGROUND

Emergency Department (ED) crowding is a pervasive problem, yet there have been few comparisons of the extent of, and contributors to, crowding among different types of EDs. The study quantifies and compares crowding metrics for 16 high volume regional, urban and academic EDs in one Canadian province.

METHODS

The National Ambulatory Care Reporting System (NACRS) provided ED presentations by adults to 16 high volume Alberta EDs during April 2010 to March 2015 for this retrospective cohort study. Time to physician initial assessment (PIA), length of stay (LOS) for discharges and admissions were grouped by start hour of presentation and facility. Multiple crowding metrics were created by taking the means, medians (PIA-M, LOS-M), and 90th percentiles of the hourly, ED-specific values. Similarly, proportion left against medical advice (LAMA) and proportion left without being seen (LWBS) were day and ED aggregated. Calculated based on the start of the presentation and the facility and for PIA and LOS. The mean, median, and 90th percentiles for the date and time ED-specific metrics for PIA and LOS were obtained. Summary statistics were used to describe crowding metrics.

RESULTS

There were 3,925,457 presentations by 1,420,679 adults. The number of presentations was similar for each sex and the mean age was 46 years. Generally, the three categories of EDs had similar characteristics; however, urban and academic/teaching EDs had more urgent triage scores and a higher percentage of admissions than regional EDs. The median of the PIA-M metric was 1 h23m across all EDs. For discharges, the median of the LOS-M metric was 3h21m whereas the median of the LOS-M metric for admissions was 10h08m. Generally, regional EDs had shorter times than urban and academic/teaching EDs. The median daily LWBS was 3.4% and the median daily LAMA was about 1%.

CONCLUSIONS

Emergency presentations have increased over time, and crowding metrics vary considerably among EDs and over the time of day. Academic/teaching EDs generally have higher crowding metrics than other EDs and urgent action is required to mitigate the well-known consequences of ED crowding.

Authors+Show Affiliations

Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada. School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada.Department of Emergency Medicine, University of Calgary, C231 Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada. rhonda.rosychuk@ualberta.ca. Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada. rhonda.rosychuk@ualberta.ca. Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada. rhonda.rosychuk@ualberta.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32336295

Citation

Rowe, Brian H., et al. "Temporal Trends in Emergency Department Volumes and Crowding Metrics in a Western Canadian Province: a Population-based, Administrative Data Study." BMC Health Services Research, vol. 20, no. 1, 2020, p. 356.
Rowe BH, McRae A, Rosychuk RJ. Temporal trends in emergency department volumes and crowding metrics in a western Canadian province: a population-based, administrative data study. BMC Health Serv Res. 2020;20(1):356.
Rowe, B. H., McRae, A., & Rosychuk, R. J. (2020). Temporal trends in emergency department volumes and crowding metrics in a western Canadian province: a population-based, administrative data study. BMC Health Services Research, 20(1), 356. https://doi.org/10.1186/s12913-020-05196-4
Rowe BH, McRae A, Rosychuk RJ. Temporal Trends in Emergency Department Volumes and Crowding Metrics in a Western Canadian Province: a Population-based, Administrative Data Study. BMC Health Serv Res. 2020 Apr 26;20(1):356. PubMed PMID: 32336295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Temporal trends in emergency department volumes and crowding metrics in a western Canadian province: a population-based, administrative data study. AU - Rowe,Brian H, AU - McRae,Andrew, AU - Rosychuk,Rhonda J, Y1 - 2020/04/26/ PY - 2019/10/28/received PY - 2020/04/06/accepted PY - 2020/4/28/entrez PY - 2020/4/28/pubmed PY - 2020/11/20/medline KW - Admission KW - Crowding metrics KW - Emergency department KW - Patient flow SP - 356 EP - 356 JF - BMC health services research JO - BMC Health Serv Res VL - 20 IS - 1 N2 - BACKGROUND: Emergency Department (ED) crowding is a pervasive problem, yet there have been few comparisons of the extent of, and contributors to, crowding among different types of EDs. The study quantifies and compares crowding metrics for 16 high volume regional, urban and academic EDs in one Canadian province. METHODS: The National Ambulatory Care Reporting System (NACRS) provided ED presentations by adults to 16 high volume Alberta EDs during April 2010 to March 2015 for this retrospective cohort study. Time to physician initial assessment (PIA), length of stay (LOS) for discharges and admissions were grouped by start hour of presentation and facility. Multiple crowding metrics were created by taking the means, medians (PIA-M, LOS-M), and 90th percentiles of the hourly, ED-specific values. Similarly, proportion left against medical advice (LAMA) and proportion left without being seen (LWBS) were day and ED aggregated. Calculated based on the start of the presentation and the facility and for PIA and LOS. The mean, median, and 90th percentiles for the date and time ED-specific metrics for PIA and LOS were obtained. Summary statistics were used to describe crowding metrics. RESULTS: There were 3,925,457 presentations by 1,420,679 adults. The number of presentations was similar for each sex and the mean age was 46 years. Generally, the three categories of EDs had similar characteristics; however, urban and academic/teaching EDs had more urgent triage scores and a higher percentage of admissions than regional EDs. The median of the PIA-M metric was 1 h23m across all EDs. For discharges, the median of the LOS-M metric was 3h21m whereas the median of the LOS-M metric for admissions was 10h08m. Generally, regional EDs had shorter times than urban and academic/teaching EDs. The median daily LWBS was 3.4% and the median daily LAMA was about 1%. CONCLUSIONS: Emergency presentations have increased over time, and crowding metrics vary considerably among EDs and over the time of day. Academic/teaching EDs generally have higher crowding metrics than other EDs and urgent action is required to mitigate the well-known consequences of ED crowding. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/32336295/Temporal_trends_in_emergency_department_volumes_and_crowding_metrics_in_a_western_Canadian_province:_a_population_based_administrative_data_study_ L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05196-4 DB - PRIME DP - Unbound Medicine ER -