Abstract
Background: Hospital emergency departments (ED) can contribute to improve health outcomes and reduce costs of health care system. This study evaluated ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care in order to understand factors involved in ED overcrowding and promote adequate management. Methods: This retrospective study analyzed a twelve months window, with in-depth focus on December/January when almost all EDs reported overcrowding. All ED admissions were recorded in electronic schedules including: demographic characteristics, time/date of the access, incoming triage code, diagnosis, performed procedures, discharge, time/date of discharge. A backward multivariable logistic regression model was used to estimate relationships between investigated variables and ED pattern mortality. Results: A total of 416,299 ED admissions were analyzed. During the overcrowded period there was an increase in patients admissions (+32 patients per day, p = 0.0079) with a statistically significant rise of critical patients (+1.7% yellow codes and +0.7% red codes, p < 0.001) and older subjects (+1.4% patients aged 75 or more years, p < 0.001). Moreover, there were statistically significant increases in waiting times and in length of visits, a higher percentage of patients who were hospitalized (13.3% vs. 12.2%, p < 0.001), left ED (4.46% vs. 4.15%, p < 0.001) and died (0.27% vs. 0.17%, p < 0.0001). This latter result maintained a marginal statistical significance (OR = 1.16, 95% CI = 0.98–1.38, p = 0.075) after adjustment for confounding. Conclusion: Our study highlights that ED crowding can determine measurable worsening in ED services and patient outcomes as mortality, waiting times, lengths of stay, percentage of abandonment without being seen and, probably, costs. Thus, address ED crowding has to be considered an important public health priority requiring policymakers involvement.
Highlights
Hospital emergency departments (ED) play a key role in the health care system, addressing emergent or urgent health problems, whose treatment often cannot be delayed
This study evaluated ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care in order to understand factors involved in ED overcrowding and promote adequate management
Following the previous considerations and in order to answer some unsolved questions, this study evaluates ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care
Summary
Hospital emergency departments (ED) play a key role in the health care system, addressing emergent or urgent health problems, whose treatment often cannot be delayed. Emergency physicians are demanded to provide high quality emergency care to all patients in a safe and timely manner but this goal cannot be reached without a clear and efficient organization of the services. Some authors have reported that these challenges have resulted in ED overcrowding, too long waiting times, inefficiencies in providing care, patient discomfort, and longer in-hospital length of stay [2,3]. Other important consequences of overcrowding include a general perception of being rushed by emergency physicians and staff and a high frequency of patients leaving the ED with no visit. Great efforts have been made in Italy to reduce hospital care costs fulfilling the health needs of the population. Following the previous considerations and in order to answer some unsolved questions, this study evaluates ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care
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