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Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments.
J Am Coll Emerg Physicians Open. 2020 Dec; 1(6):1297-1303.JA

Abstract

Objective

Our investigation compared throughput metrics and utilization measures for freestanding emergency departments (FSEDs) versus hospital-based emergency departments (HBEDs) of similar volumes in the United States.

Methods

This study is a cross sectional survey of 183 FSEDs and 317 HBEDs located across the United States using the Emergency Department Benchmarking Alliance (EDBA) Database. We measured common emergency department (ED) throughput metrics. Primary outcomes included overall length of stay, length of stay for admitted, and length of stay for treated and released patients. Outcomes were weighted based on the proportion of ED volume per facility as per a prior pilot study. Multiple linear regression analysis was used to adjust for measured differences between FSEDs and HBEDs. The variables that were controlled for in regression analysis included geographic location of the ED (urban, suburban, and rural), percent of high acuity capacity, ED volume, percentage of patients arriving via emergency medical services (EMS), and percentage of pediatric patients.

Results

Nationally, the median length of stay in minutes (104.2 vs 140.0), length of stay for treated and released patients (98.6 vs 122.9), door-to-bed (4.0 vs 8.0), door-to-doctor (11.0 vs 16.0), percentage of patients admitted through the ED (4.0 vs 11.0), and percentage of patients leaving the ED without being seen (LWBS) (0.9 vs 1.5), were significantly lower at FSEDs compared to HBEDs (P < 0.0001 for all comparisons). Length of stay for admitted patients (265.9 vs 241.8) and median boarding time (96.8 vs. 71.3) were significantly lower in HBEDs compared to FSEDs. X-ray, computed tomography, and ECG utilization per 100 patients was significantly lower at the FSEDs compared to HBEDs. Multiple linear regression analysis demonstrated that the length of stay for treated and released patients was 8.67 minutes shorter for FSEDs as compared to HBEDs (95% confidence interval [CI] = -1.4 to -16.0). The length of stay for admitted patients was 44 minutes longer for FSEDs as compared to HBEDs (95% CI = 25.5 to 63.0).

Conclusions

In this study of similarly sized EDs in the United States, throughput metrics for FSEDs tended to be significantly shorter from the arrival of the patient until their departure, except for patients requiring hospital admission. For measures favoring FSEDs, throughput times range from 20%-50% shorter than HBEDs.

Authors+Show Affiliations

Henry J.N. Taub Department of Emergency Medicine Baylor College of Medicine Houston Texas USA.Department of Emergency Medicine University of Massachusetts Memorial Medical Center Worcester Massachusetts USA.Department of Research Cleveland Clinic Akron General Akron Ohio USA.Department of Emergency Medicine Northeast Ohio Medical University Rootstown Ohio USA.Cleveland Clinic Akron General Department of Emergency Medicine Northeast Ohio Medical University Rootstown Ohio USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33392536

Citation

Dark, Cedric, et al. "Estimates of Throughput and Utilization at Freestanding Compared to Low-volume Hospital-based Emergency Departments." Journal of the American College of Emergency Physicians Open, vol. 1, no. 6, 2020, pp. 1297-1303.
Dark C, Canellas M, Mangira C, et al. Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments. J Am Coll Emerg Physicians Open. 2020;1(6):1297-1303.
Dark, C., Canellas, M., Mangira, C., Jouriles, N., & Simon, E. L. (2020). Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments. Journal of the American College of Emergency Physicians Open, 1(6), 1297-1303. https://doi.org/10.1002/emp2.12318
Dark C, et al. Estimates of Throughput and Utilization at Freestanding Compared to Low-volume Hospital-based Emergency Departments. J Am Coll Emerg Physicians Open. 2020;1(6):1297-1303. PubMed PMID: 33392536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments. AU - Dark,Cedric, AU - Canellas,Maureen, AU - Mangira,Caroline, AU - Jouriles,Nick, AU - Simon,Erin L, Y1 - 2020/11/20/ PY - 2020/05/27/received PY - 2020/10/20/revised PY - 2020/10/23/accepted PY - 2021/1/4/entrez PY - 2021/1/5/pubmed PY - 2021/1/5/medline SP - 1297 EP - 1303 JF - Journal of the American College of Emergency Physicians open JO - J Am Coll Emerg Physicians Open VL - 1 IS - 6 N2 - Objective: Our investigation compared throughput metrics and utilization measures for freestanding emergency departments (FSEDs) versus hospital-based emergency departments (HBEDs) of similar volumes in the United States. Methods: This study is a cross sectional survey of 183 FSEDs and 317 HBEDs located across the United States using the Emergency Department Benchmarking Alliance (EDBA) Database. We measured common emergency department (ED) throughput metrics. Primary outcomes included overall length of stay, length of stay for admitted, and length of stay for treated and released patients. Outcomes were weighted based on the proportion of ED volume per facility as per a prior pilot study. Multiple linear regression analysis was used to adjust for measured differences between FSEDs and HBEDs. The variables that were controlled for in regression analysis included geographic location of the ED (urban, suburban, and rural), percent of high acuity capacity, ED volume, percentage of patients arriving via emergency medical services (EMS), and percentage of pediatric patients. Results: Nationally, the median length of stay in minutes (104.2 vs 140.0), length of stay for treated and released patients (98.6 vs 122.9), door-to-bed (4.0 vs 8.0), door-to-doctor (11.0 vs 16.0), percentage of patients admitted through the ED (4.0 vs 11.0), and percentage of patients leaving the ED without being seen (LWBS) (0.9 vs 1.5), were significantly lower at FSEDs compared to HBEDs (P < 0.0001 for all comparisons). Length of stay for admitted patients (265.9 vs 241.8) and median boarding time (96.8 vs. 71.3) were significantly lower in HBEDs compared to FSEDs. X-ray, computed tomography, and ECG utilization per 100 patients was significantly lower at the FSEDs compared to HBEDs. Multiple linear regression analysis demonstrated that the length of stay for treated and released patients was 8.67 minutes shorter for FSEDs as compared to HBEDs (95% confidence interval [CI] = -1.4 to -16.0). The length of stay for admitted patients was 44 minutes longer for FSEDs as compared to HBEDs (95% CI = 25.5 to 63.0). Conclusions: In this study of similarly sized EDs in the United States, throughput metrics for FSEDs tended to be significantly shorter from the arrival of the patient until their departure, except for patients requiring hospital admission. For measures favoring FSEDs, throughput times range from 20%-50% shorter than HBEDs. SN - 2688-1152 UR - https://www.unboundmedicine.com/medline/citation/33392536/Estimates_of_throughput_and_utilization_at_freestanding_compared_to_low_volume_hospital_based_emergency_departments_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33392536/ DB - PRIME DP - Unbound Medicine ER -
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