Abstract
BackgroundEmergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home.MethodsThis pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the χ2 and Fisher exact tests.ResultsOver half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P = 0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P <0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P = 0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P = 0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P = 0.46.ConclusionsED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes.
Highlights
Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care
Our objectives were to determine whether: 1) patients were triaged to non-monitored areas of the ED more frequently during ED crowding; 2) patients were assessed by a physician more quickly in non-monitored rather than monitored areas during crowded conditions; 3) patients triaged to the non-monitored area received the same laboratory and imaging tests as those triaged to monitored areas; 4) patients triaged during ED crowding received the same laboratory and imaging tests as those triaged during non-crowded conditions; 5) the proportion of return ED visits was higher for patients triaged during ED crowding; and 6) the proportion of return ED visits was higher for patients triaged to the non-monitored area during crowded conditions
Study flow We found 568 eligible health records during the study period; 7 visits were excluded for a Canadian Triage and Acuity Scale (CTAS) score other than 2 and 61 charts were excluded based on chief complaint
Summary
Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. We aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. Research has since focused on the effect of ED crowding on adverse patient outcomes; the effect of ED crowding on triage destination has not been studied. We present a pilot study of patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were discharged home on the index visit. Our objectives were to determine whether: 1) patients were triaged to non-monitored areas of the ED more frequently during ED crowding; 2) patients were assessed by a physician more quickly in non-monitored rather than monitored areas during crowded conditions; 3) patients triaged to the non-monitored area received the same laboratory and imaging tests as those triaged to monitored areas; 4) patients triaged during ED crowding received the same laboratory and imaging tests as those triaged during non-crowded conditions; 5) the proportion of return ED visits was higher for patients triaged during ED crowding; and 6) the proportion of return ED visits was higher for patients triaged to the non-monitored area during crowded conditions
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