Emergency department crowding predicts admission length-of-stay but not mortality in a large health system

Stephen F. Derose, Gelareh Z. Gabayan, Vicki Y. Chiu, Sau C. Yiu, Benjamin Sun

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: Emergency department (ED) crowding has been identified as a major threat to public health. OBJECTIVES: We assessed patient transit times and ED system crowding measures based on their associations with outcomes. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: We accessed electronic health record data on 136,740 adults with a visit to any of 13 health system EDs from January 2008 to December 2010. MEASURES: Patient transit times (waiting, evaluation and treatment, boarding) and ED system crowding [nonindex patient length-of-stay (LOS) and boarding, bed occupancy] were determined. Outcomes included individual inpatient mortality and admission LOS. Covariates included demographic characteristics, past comorbidities, severity of illness, arrival time, and admission diagnoses. RESULTS: No patient transit time or ED system crowding measure predicted increased mortality after control for patient characteristics. Index patient boarding time and lower bed occupancy were associated with admission LOS (based on nonoverlapping 95% CI vs. the median value). As boarding time increased from none to 14 hours, admission LOS increased an additional 6 hours. As mean occupancy decreased below the median (80% occupancy), admission LOS decreased as much as 9 hours. CONCLUSIONS: Measures indicating crowded ED conditions were not predictive of mortality after case-mix adjustment. The first half-day of boarding added to admission LOS rather than substituted for it. Our findings support the use of boarding time as a measure of ED crowding based on robust prediction of admission LOS. Interpretation of measures based on other patient ED transit times may be limited to the timeliness of care.

Original languageEnglish (US)
Pages (from-to)602-611
Number of pages10
JournalMedical Care
Volume52
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Hospital Emergency Service
Length of Stay
Mortality
Health
Bed Occupancy
Risk Adjustment
Electronic Health Records
Comorbidity
Inpatients
Cohort Studies
Retrospective Studies
Public Health
Demography

Keywords

  • ED crowding
  • emergency care
  • emergency medicine
  • inpatient mortality
  • length-of-stay

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Emergency department crowding predicts admission length-of-stay but not mortality in a large health system. / Derose, Stephen F.; Gabayan, Gelareh Z.; Chiu, Vicki Y.; Yiu, Sau C.; Sun, Benjamin.

In: Medical Care, Vol. 52, No. 7, 2014, p. 602-611.

Research output: Contribution to journalArticle

Derose, Stephen F. ; Gabayan, Gelareh Z. ; Chiu, Vicki Y. ; Yiu, Sau C. ; Sun, Benjamin. / Emergency department crowding predicts admission length-of-stay but not mortality in a large health system. In: Medical Care. 2014 ; Vol. 52, No. 7. pp. 602-611.
@article{d92b0b81a33449a8aabe7a8be89fd435,
title = "Emergency department crowding predicts admission length-of-stay but not mortality in a large health system",
abstract = "BACKGROUND: Emergency department (ED) crowding has been identified as a major threat to public health. OBJECTIVES: We assessed patient transit times and ED system crowding measures based on their associations with outcomes. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: We accessed electronic health record data on 136,740 adults with a visit to any of 13 health system EDs from January 2008 to December 2010. MEASURES: Patient transit times (waiting, evaluation and treatment, boarding) and ED system crowding [nonindex patient length-of-stay (LOS) and boarding, bed occupancy] were determined. Outcomes included individual inpatient mortality and admission LOS. Covariates included demographic characteristics, past comorbidities, severity of illness, arrival time, and admission diagnoses. RESULTS: No patient transit time or ED system crowding measure predicted increased mortality after control for patient characteristics. Index patient boarding time and lower bed occupancy were associated with admission LOS (based on nonoverlapping 95{\%} CI vs. the median value). As boarding time increased from none to 14 hours, admission LOS increased an additional 6 hours. As mean occupancy decreased below the median (80{\%} occupancy), admission LOS decreased as much as 9 hours. CONCLUSIONS: Measures indicating crowded ED conditions were not predictive of mortality after case-mix adjustment. The first half-day of boarding added to admission LOS rather than substituted for it. Our findings support the use of boarding time as a measure of ED crowding based on robust prediction of admission LOS. Interpretation of measures based on other patient ED transit times may be limited to the timeliness of care.",
keywords = "ED crowding, emergency care, emergency medicine, inpatient mortality, length-of-stay",
author = "Derose, {Stephen F.} and Gabayan, {Gelareh Z.} and Chiu, {Vicki Y.} and Yiu, {Sau C.} and Benjamin Sun",
year = "2014",
doi = "10.1097/MLR.0000000000000141",
language = "English (US)",
volume = "52",
pages = "602--611",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Emergency department crowding predicts admission length-of-stay but not mortality in a large health system

AU - Derose, Stephen F.

AU - Gabayan, Gelareh Z.

AU - Chiu, Vicki Y.

AU - Yiu, Sau C.

AU - Sun, Benjamin

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Emergency department (ED) crowding has been identified as a major threat to public health. OBJECTIVES: We assessed patient transit times and ED system crowding measures based on their associations with outcomes. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: We accessed electronic health record data on 136,740 adults with a visit to any of 13 health system EDs from January 2008 to December 2010. MEASURES: Patient transit times (waiting, evaluation and treatment, boarding) and ED system crowding [nonindex patient length-of-stay (LOS) and boarding, bed occupancy] were determined. Outcomes included individual inpatient mortality and admission LOS. Covariates included demographic characteristics, past comorbidities, severity of illness, arrival time, and admission diagnoses. RESULTS: No patient transit time or ED system crowding measure predicted increased mortality after control for patient characteristics. Index patient boarding time and lower bed occupancy were associated with admission LOS (based on nonoverlapping 95% CI vs. the median value). As boarding time increased from none to 14 hours, admission LOS increased an additional 6 hours. As mean occupancy decreased below the median (80% occupancy), admission LOS decreased as much as 9 hours. CONCLUSIONS: Measures indicating crowded ED conditions were not predictive of mortality after case-mix adjustment. The first half-day of boarding added to admission LOS rather than substituted for it. Our findings support the use of boarding time as a measure of ED crowding based on robust prediction of admission LOS. Interpretation of measures based on other patient ED transit times may be limited to the timeliness of care.

AB - BACKGROUND: Emergency department (ED) crowding has been identified as a major threat to public health. OBJECTIVES: We assessed patient transit times and ED system crowding measures based on their associations with outcomes. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: We accessed electronic health record data on 136,740 adults with a visit to any of 13 health system EDs from January 2008 to December 2010. MEASURES: Patient transit times (waiting, evaluation and treatment, boarding) and ED system crowding [nonindex patient length-of-stay (LOS) and boarding, bed occupancy] were determined. Outcomes included individual inpatient mortality and admission LOS. Covariates included demographic characteristics, past comorbidities, severity of illness, arrival time, and admission diagnoses. RESULTS: No patient transit time or ED system crowding measure predicted increased mortality after control for patient characteristics. Index patient boarding time and lower bed occupancy were associated with admission LOS (based on nonoverlapping 95% CI vs. the median value). As boarding time increased from none to 14 hours, admission LOS increased an additional 6 hours. As mean occupancy decreased below the median (80% occupancy), admission LOS decreased as much as 9 hours. CONCLUSIONS: Measures indicating crowded ED conditions were not predictive of mortality after case-mix adjustment. The first half-day of boarding added to admission LOS rather than substituted for it. Our findings support the use of boarding time as a measure of ED crowding based on robust prediction of admission LOS. Interpretation of measures based on other patient ED transit times may be limited to the timeliness of care.

KW - ED crowding

KW - emergency care

KW - emergency medicine

KW - inpatient mortality

KW - length-of-stay

UR - http://www.scopus.com/inward/record.url?scp=84902436724&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902436724&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000000141

DO - 10.1097/MLR.0000000000000141

M3 - Article

VL - 52

SP - 602

EP - 611

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 7

ER -