Abstract
BackgroundEmergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, the association between emergency department crowding and the occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and the incidence of in-hospital cardiac arrest.MethodsA single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at the time of presentation of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is the association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates.ResultsDuring the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality.ConclusionMaximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest.
Highlights
Emergency department (ED) overcrowding is a global phenomenon with complex causes that are not fully understood [1, 2]
Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence
During the study period, 629 adult, non-traumatic patients experiencing of-hospital cardiac arrest (OHCA) and In-hospital cardiac arrest (IHCA) were enrolled in our registry
Summary
The imbalance of supply and demand in ED capacity can result in hazardous effects both on physicians and patients [3], and previous studies have found that overcrowded ED conditions increased physician decision-making time [4], led to more medication errors [5], decreased quality of care [6], and increased mortality during hospital stay [7, 8]. These potential dangers can be detrimental for patients who needed time-critical interventions to effectively treat emergency conditions such as acute stroke [9], acute respiratory failure [10], and septic shock [11].
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