S0020 The Effect of ER Crowding on Time to Fluid Initiation in Acute Pancreatitis

Abstract

INTRODUCTION: Studies suggest that early fluid resuscitation in acute pancreatitis may improve outcomes. Thus, the timely diagnosis and treatment in the emergency room is vital. One factor consistently implicated in delay of care is ER crowding, which has been associated with increased inpatient mortality, longer hospital length of stay and higher healthcare costs. The primary aim of our study is to evaluate the effects of ER crowding on time to fluid initiation in patients who present to the emergency room with acute pancreatitis. METHODS: An observational cohort of consecutive unique patients who presented to the LAC + USC emergency room for acute pancreatitis between June 2015 and April 2017 were included. The time that the patient’s first set of vitals was recorded upon presentation to the emergency room triage was labeled as “time zero,” and the time that fluids were started was labeled as “time to fluid initiation.” The crowding level of the LAC + USC emergency room was determined by the National Emergency Department Overcrowding Scale (NEDOCS) at the time of patient presentation and was recorded on a scale from 1 to 4 (1 = normal, 2 = busy, 3 = overcrowded, 4 = severe). The primary endpoint was time to fluid initiation. Detailed demographic information, pancreatitis etiology, and medical history was recorded. Linear regression analysis to analyze the relationship between the crowding level to the time to fluid initiation. RESULTS: Overall, 42 patients presented when the ER had normal (level 1) crowding, 111 patients while it was busy (level 2), 119 patients while it was overcrowded (level 3) and 58 patients while it was (level 4) severely crowded. The features of the 330 patients stratified by crowding level was similar. Most of the patients in our study were of Hispanic ethnicity, 44% female, and 39% had comorbidities. Gallstone pancreatitis was the most common etiology. The time to fluid initiation was strongly correlated with ER crowding level and was significantly increased for each step increase in crowding (p < 0.001). It increased from 1.83 (±1.25 hours) in normal conditions to 2.78 (±2.5) hours when the ER was busy to 5.41 (±5) when overcrowded, and 7.1 (+6.8) when the condition was severe. CONCLUSION: ER overcrowding is strongly correlated with a delay in time to fluid initiation in patients with acute pancreatitis. Pathways to rapidly identify and trigger treatment are needed.Figure 1