Grant D Innes1, Marco L A Sivilotti2, Howard Ovens3, Kirstie McLelland4, Adam Dukelow5, Edmund Kwok6, Anil Chopra7, Ivy Cheng8, Dan Kalla9, David Mackinnon10, Chad Kim Sing11, Neil Barclay12, Terry Ross13, Alecs Chochinov14. 1. *Alberta Health Services,Departments of Emergency Medicine and Community Health Services,University of Calgary,Calgary, AB. 2. †Department of Emergency Medicine,Kingston Health Sciences Centre,Queen's University,Kingston, ON. 3. ‡Department of Emergency Medicine,Sinai Health System,Toronto,ON. 4. §Department of Emergency Medicine,Alberta Health Services,University of Alberta,Edmonton,AB. 5. ¶Department of Emergency Medicine,London Health Sciences Centre,London,ON. 6. **Department of Emergency Medicine,The Ottawa Hospital,Ottawa,ON. 7. ††Department of Emergency Medicine,University Health Network,Toronto,ON. 8. ‡‡Department of Emergency Medicine,Sunnybrook Hospital,University of Toronto,Toronto,ON. 9. §§Department of Emergency Medicine,Providence Healthcare,St. Paul's Hospital,Vancouver,BC. 10. ¶¶Department of Emergency Medicine,St. Michael's Hospital,Toronto,ON. 11. ***Department of Emergency Medicine,Vancouver General Hospital,Vancouver,BC. 12. †††Department of Emergency Medicine,Fraser Health,University of British Columbia,Surrey,BC. 13. ‡‡‡Department of Emergency Medicine,Regina General Hospital,Pasqua Hospital,Regina,SK. 14. §§§Department of Emergency Medicine,Winnipeg Regional Health Authority,University of Manitoba,Winnipeg,MB.
Abstract
OBJECTIVES: Emergency department (ED) access block, the inability to provide timely care for high acuity patients, is the leading safety concern in First World EDs. The main cause of ED access block is hospital access block with prolonged boarding of inpatients in emergency stretchers. Cumulative emergency access gap, the product of the number of arriving high acuity patients and their average delay to reach a care space, is a novel access measure that provides a facility-level estimate of total emergency care delays. Many health leaders believe these delays are too large to be solved without substantial increases in hospital capacity. Our objective was to quantify cumulative emergency access blocks (the problem) as a fraction of inpatient capacity (the potential solution) at a large sample of Canadian hospitals. METHODS: In this cross-sectional study, we collated 2015 administrative data from 25 Canadian hospitals summarizing patient inflow and delays to ED care space. Cumulative access gap for high acuity patients was calculated by multiplying the number of Canadian Triage Acuity Scale (CTAS) 1-3 patients by their average delay to reach a care space. We compared cumulative ED access gap to available inpatient bed hours to estimate fractional access gap. RESULTS: Study sites included 16 tertiary and 9 community EDs in 12 cities, representing 1.79 million patient visits. Median ED census (interquartile range) was 66,300 visits per year (58,700-80,600). High acuity patients accounted for 70.7% of visits (60.9%-79.0%). The mean (SD) cumulative ED access gap was 46,000 stretcher hours per site per year (± 19,900), which was 1.14% (± 0.45%) of inpatient capacity. CONCLUSION: ED access gaps are large and jeopardize care for high acuity patients, but they are small relative to hospital operating capacity. If access block were viewed as a "whole hospital" problem, capacity or efficiency improvements in the range of 1% to 3% could profoundly mitigate emergency care delays.
OBJECTIVES: Emergency department (ED) access block, the inability to provide timely care for high acuity patients, is the leading safety concern in First World EDs. The main cause of ED access block is hospital access block with prolonged boarding of inpatients in emergency stretchers. Cumulative emergency access gap, the product of the number of arriving high acuity patients and their average delay to reach a care space, is a novel access measure that provides a facility-level estimate of total emergency care delays. Many health leaders believe these delays are too large to be solved without substantial increases in hospital capacity. Our objective was to quantify cumulative emergency access blocks (the problem) as a fraction of inpatient capacity (the potential solution) at a large sample of Canadian hospitals. METHODS: In this cross-sectional study, we collated 2015 administrative data from 25 Canadian hospitals summarizing patient inflow and delays to ED care space. Cumulative access gap for high acuity patients was calculated by multiplying the number of Canadian Triage Acuity Scale (CTAS) 1-3 patients by their average delay to reach a care space. We compared cumulative ED access gap to available inpatient bed hours to estimate fractional access gap. RESULTS: Study sites included 16 tertiary and 9 community EDs in 12 cities, representing 1.79 million patient visits. Median ED census (interquartile range) was 66,300 visits per year (58,700-80,600). High acuity patients accounted for 70.7% of visits (60.9%-79.0%). The mean (SD) cumulative ED access gap was 46,000 stretcher hours per site per year (± 19,900), which was 1.14% (± 0.45%) of inpatient capacity. CONCLUSION: ED access gaps are large and jeopardize care for high acuity patients, but they are small relative to hospital operating capacity. If access block were viewed as a "whole hospital" problem, capacity or efficiency improvements in the range of 1% to 3% could profoundly mitigate emergency care delays.
Authors: Robin Clouston; Paul Atkinson; Donaldo D Canales; Jacqueline Fraser; Dylan Sohi; Scott Lee; Michael Howlett Journal: CJEM Date: 2021-03-21 Impact factor: 2.410