Abstract
There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality. This was an observational cohort study including visits from 14 EDs in Sweden 2015-2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed. 2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01-1.12) in the moderate crowding category, and 1.11 (1.01-1.22) in the high category. The association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role.
Highlights
BackgroundEmergency department (ED) crowding is a global challenge, and there is overwhelming evidence of negative consequences to both patients and staff [1]
The measure was associated with increased 30-day mortality, but this has so far not been confirmed in other studies and settings
Data originates from the various electronic health care (EHR) records in the hospitals and all emergency department (ED) visits are automatically uploaded to Svenska Akutvårdsregistret” (SVAR) on a daily basis
Summary
Emergency department (ED) crowding is a global challenge, and there is overwhelming evidence of negative consequences to both patients and staff [1]. Crowding has been shown to be associated with increased mortality [10,11,12,13]. In our prior study [10], including almost all ED patient visits in the Stockholm County during 2012–2016, a new proxy-measure of ED crowding was introduced and defined as the mean ED census divided by the expected ED census during a shift at the particular ED. The measure was associated with increased 30-day mortality, but this has so far not been confirmed in other studies and settings
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have