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Understanding hospital and emergency department congestion: an examination of inpatient admission trends and bed resources

  • Hannah J. Wong (a1) (a2) (a3), Dante Morra (a4) (a5), Michael Caesar (a2), Michael W. Carter (a1) (a2) and Howard Abrams (a4) (a5) (a6)...
Abstract
ABSTRACTObjective:

Patients in the emergency department (ED) who have been admitted to hospital (inpatient “boarders”) are associated with ED overcrowding. They are also a symptom of a hospital-wide imbalance between demand and supply of resources. We analyzed the trends of inpatient admissions, ED boarding volumes, lengths of stay and bed resources of 3 major admitting services at our teaching institution.

Methods:

We used hospital databases from Jan. 1, 2004, to Dec. 31, 2007, to analyze ED visits that resulted in admission to hospital.

Results:

During the study period, 21 986 ED patients were admitted to hospital. The percentage of cancer-related admissions to the oncology admitting service decreased from 48% in 2004 to 24% in 2007, and admissions to general internal medicine (GIM) increased nearly 2-fold, from 28% in 2004 to 54% in 2007. In addition, GIM admitted about 10% more myocardial infarction and heart failure patients than did cardiology. General internal medicine constituted the majority of ED boarders and had a median boarding length of stay of approximately 15 hours. Inpatient beds on oncology and cardiology services remained static.

Conclusion:

Without bed capacity to admit more patients, our specialty services relied on GIM to serve as a safety net. At the same time, GIM was cited as a main source of ED congestion as their patients occupied more ED beds for longer periods than any other admitting service. The data presented in this study has helped effect positive change within our institution. Other hospitals running at or near capacity and faced with similar ED congestion may apply the methods we used in this study to analyze the cause and nature of their situation.

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Copyright
Corresponding author
Toronto General Hospital, 200 Elizabeth St., EN 14-216, Toronto ON M5G 2C4; howard.abrams@uhn.on.ca
References
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1.Ospina MB, Bond K, Schull M, et al. Key indicators of overcrowding in Canadian emergency departments: a Delphi study. CJEM 2007;9:339–46.
2.Andrulis DP, Kellermann A, Hintz EA, et al. Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med 1991;20:980–6.
3.Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005;22:351–4.
4.Canadian Institute for Health Information. Understanding emergency department wait times: access to inpatient beds and patient flow. Ottawa (ON): The Institute; 2007. Available: http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_792_E&cw_topic=792&cw_rel=AR_1266_E#full (accessed 2009 Sep 23).
5.Richards JR, Navarro ML, Derlet RW. Survey of directors of emergency departments in California on overcrowding. West J Med 2000;172:385–8.
6.Schull MJ, Slaughter PM, Redelmeier DA. Urban emergency department overcrowding: defining the problem and eliminating misconceptions. CJEM 2002;4:7683.
7.Asplin BR, Magid DJ. If you want to fix crowding, start by fixing your hospital. Ann Emerg Med 2007;49:273–4.
8.Forster AJ. An agenda for reducing emergency department crowding. Ann Emerg Med 2005;45:479–81.
9.DeCoster C, Roos NP, Carriere KC, et al. Inappropriate hospital use by patients receiving care for medical conditions: targeting utilization review. CMAJ 1997;157:889–96.
10.McClaran J, Tover-Berglas R, Glass KC. Chronic status patients in a university hospital: bed-day utilization and length of stay. CMAJ 1991;145:1259–65.
11.Schneider S, Zwemer F, Doniger A, et al. Rochester, New York: a decade of emergency department overcrowding. Acad Emerg Med 2001;8:1044–50.
12.Roberts DC, McKay MP, Shaffer A. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med 2007;51:769–74.
13.McDonald AJ, Pelletier AJ, Ellinor PT, et al. Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004. Ann Emerg Med 2008;51:5865.
14.McCusker J, Verdon J. Do geriatric interventions reduce emergency department visits? A systematic review. J Gerontol A Biol Sci Med Sci 2006;61:5362.
15.Salvi F, Morichi V, Grilli A, et al. The elderly in the emergency department: a critical review of problems and solutions. Intern Emerg Med 2007;2:292301.
16.Woods RA, Lee R, Ospina MB, et al. Consultation outcomes in the emergency department: exploring rates and complexity. CJEM 2008;10:2531.
17.Khare RK, Powell ES, Reinhardt G, et al. Adding more beds to the emergency department or reducing admitted patient boarding times: which has a more significant influence on emergency department congestion? Ann Emerg Med 2008
18.Olshaker JS, Rathlev NK. Emergency department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the emergency department. J Emerg Med 2006;30:351–6.
19.Canadian Association of Emergency Physicians. Joint Position Statement on emergency department overcrowding. CJEM 2001;3:82–8.
20.International classification of diseases. 10th ed., Geneva (CH): World Health Organization; 1992.
21.Abu-Laban RB. The junkyard dogs find their teeth: addressing the crisis of admitted patients in Canadian emergency departments. CJEM 2006;8:388–91.
22.Moloney ED, Bennett K, O’Riordan D, et al.Emergency department census of patients awaiting admission following reorganisation of an admissions process. Emerg Med J 2006;23:363–7.
23.Ontario Cancer Plan 2008–2011. Toronto (ON): Cancer Care Ontario; 2009. Available: http://ocp.cancercare.on.ca/ (accessed 2009 Sep 23).
24.Schull MJ, Szalai JP, Schwartz B, et al. Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;8:1037–43.
25.Kroneman M, Siegers JJ. The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries. Soc Sci Med 2004;59:1731–40.
26.Forster AJ, Stiell I, Wells G, et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003;10:127–33.
27.Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008;52:126–36.
28.Hwang JI. The relationship between hospital capacity characteristics and emergency department volumes in Korea. Health Policy 2006;79:274–83.
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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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