Effect of a holiday service reduction period on a hospital’s emergency department access block

Abstract

To study the effect of holiday service reductions, consisting of bed and theatre closures, in a tertiary paediatric hospital on various measures of ED occupancy, including access block. Retrospective comparative observational study of all 2142 ED attendances during a holiday hospital service reduction period (the 'study period'), when the hospital's bed capacity was reduced by 17% and all elective operating theatres were closed, and all 4255 attendances during two control periods at a major tertiary children's hospital, using the ED's information system to collect data. The following outcome measures were derived from the raw data and compared between the control and study groups: proportion of all intended inpatient admissions that were actual inpatient admissions; proportion of intended inpatient admissions that were discharged home from the ED; proportion of all admissions that were ED admissions; access block, that is, the percentage of patients requiring inpatient admission who have a total ED time of greater than 8 h; the mean number of patients in the ED at any particular minute ('ED occupancy'); median waiting times to reach both the general ward and the operating theatre. There were no statistically significant differences between the study group and the control group in all of the outcome measures except for access block, which showed a 16% relative improvement (49.8-41.7%) during the study period when compared with the control period (P < 0.01). At this hospital, unacceptably high levels of ED access block persist both during and outside holiday periods, despite there being mild improvement in access block during the holiday period where bed closures were balanced against the effect of other service cutbacks (e.g. closing operating theatres).