Emergency Department Crowding and Time to Care in Patients With Acute Stroke

Abstract

Emergency department (ED) crowding occurs when demands for ED care exceed the supply of available resources. Prior studies have shown that ED crowding is associated with a delay in provision of critical ED services, but the impact of ED crowding on acute stroke care has not been extensively studied. We conducted a retrospective study of patients who presented to the ED with acute stroke symptoms (ischemic stroke, transient ischemic attack, intracerebral hemorrhage) at 2 hospitals. All patients with active stroke symptoms who presented within 3 hours were included and a random sample of patients with symptoms >3 hours was used for comparison. The association between ED crowding measures (waiting room number, ED occupancy, number of admitted patients, and total patient hours) and time to head CT order, completion, and interpretation, and time to administration of thrombolysis was determined. Of 253 patients presenting with acute stroke symptoms ≤3 hours from symptom onset, 52 (21%) received thrombolysis. A random comparison group of 253 patients with symptoms >3 hours was identified. There was no significant association between ED crowding and delays in CT timing or thrombolysis in patients with symptoms ≤3 hours. Several measures of ED crowding were associated with prolonged times to CT order and completion in patients with symptoms >3 hours. ED crowding was not associated with care delays in thrombolysis-eligible patients with stroke. However, those with symptoms >3 hours do experience CT delays at higher levels of ED crowding.