Nicholas M Mohr1,2,3, Chaorong Wu4, Michael J Ward5,6, Candace D McNaughton5,6, Brett Faine1,2, Kaila Pomeranz2, Kelly Richardson1, Peter J Kaboli1,7. 1. Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, Iowa, USA. 2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 3. Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 4. Institute for Clinical and Translational Sciences, University of Iowa, Iowa City, Iowa, USA. 5. Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee, USA. 6. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 7. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Abstract
PURPOSE: Emergency department (ED) crowding is increasing and is associated with adverse patient outcomes. The objective of this study was to measure the relative impact of ED boarding on timeliness of early ED care for new patient arrivals, with a focus on the differential impact in low-volume rural hospitals. METHODS: A retrospective cohort of all patients presenting to a Veterans Health Administration (VHA) ED between 2011 and 2014. The primary exposure was the number of patients in the ED at the time of ED registration, stratified by disposition (admit, discharge, or transfer) and mental health diagnosis. The primary outcome was time-to-provider evaluation, and secondary outcomes included time-to-EKG, time-to-laboratory testing, time-to-radiography, and total ED length-of-stay. Rurality was measured using the Rural-Urban Commuting Areas. FINDINGS: A total of 5,912,368 patients were included from all 123 VHA EDs. Adjusting for acuity, new patients had longer time-to-provider when more patients were in the ED, and patients awaiting transfer for nonmental health conditions impacted time-to-provider for new patients (16.6 min delays, 95% CI: 12.3-20.7 min) more than other patient types. Rural patients saw a greater impact of crowding on care timeliness than nonrural patients (additional 5.3 min in time-to-provider per additional patient in ED, 95% CI: 4.3-6.4), and the impact of additional patients in all categories was most pronounced in the lowest-volume EDs. CONCLUSIONS: Patients seen in EDs with more crowding have small, but additive, delays in early elements of ED care, and transferring patients with nonmental health diagnoses from rural facilities were associated with the greatest impact.
PURPOSE: Emergency department (ED) crowding is increasing and is associated with adverse patient outcomes. The objective of this study was to measure the relative impact of ED boarding on timeliness of early ED care for new patient arrivals, with a focus on the differential impact in low-volume rural hospitals. METHODS: A retrospective cohort of all patients presenting to a Veterans Health Administration (VHA) ED between 2011 and 2014. The primary exposure was the number of patients in the ED at the time of ED registration, stratified by disposition (admit, discharge, or transfer) and mental health diagnosis. The primary outcome was time-to-provider evaluation, and secondary outcomes included time-to-EKG, time-to-laboratory testing, time-to-radiography, and total ED length-of-stay. Rurality was measured using the Rural-Urban Commuting Areas. FINDINGS: A total of 5,912,368 patients were included from all 123 VHA EDs. Adjusting for acuity, new patients had longer time-to-provider when more patients were in the ED, and patients awaiting transfer for nonmental health conditions impacted time-to-provider for new patients (16.6 min delays, 95% CI: 12.3-20.7 min) more than other patient types. Rural patients saw a greater impact of crowding on care timeliness than nonrural patients (additional 5.3 min in time-to-provider per additional patient in ED, 95% CI: 4.3-6.4), and the impact of additional patients in all categories was most pronounced in the lowest-volume EDs. CONCLUSIONS: Patients seen in EDs with more crowding have small, but additive, delays in early elements of ED care, and transferring patients with nonmental health diagnoses from rural facilities were associated with the greatest impact.
Authors: M Christien Van Der Linden; Munawar Khursheed; Khairunnissa Hooda; Jesse M Pines; Naomi Van Der Linden Journal: Int Emerg Nurs Date: 2017-06-26 Impact factor: 2.142
Authors: Benjamin C Sun; Renee Y Hsia; Robert E Weiss; David Zingmond; Li-Jung Liang; Weijuan Han; Heather McCreath; Steven M Asch Journal: Ann Emerg Med Date: 2012-12-06 Impact factor: 5.721
Authors: Nicholas M Mohr; Chaorong Wu; Michael J Ward; Candace D McNaughton; Kelly Richardson; Peter J Kaboli Journal: BMC Health Serv Res Date: 2020-02-12 Impact factor: 2.655