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Evaluating the effect of emergency department crowding on triage destination.

O'Connor E, Gatien M, Weir C, Calder L - Int J Emerg Med (2014)

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada.

ABSTRACT

Background: Emergency 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.

Methods: This 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 χ(2) and Fisher exact tests.

Results: Over 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.

Conclusions: ED 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.

No MeSH data available.


Related in: MedlinePlus

Investigations ordered for high acuity ED patients triaged either to the non-monitored or monitored areas of the ED, presenting with chest pain or with shortness of breath. (a) Blood-work ordered. (b) Imaging and ECGs ordered. [CBC, Complete Blood Count; BUN, Blood Urea Nitrogen; CK, Creatinine Kinase; TnI, Troponin I; VBG, Venous Blood Gas; ABG, Arterial Blood Gas; CXR, Chest Radiograph; CT Chest, Chest Computed Tomography; ECG, Electrocardiogram].
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Figure 4: Investigations ordered for high acuity ED patients triaged either to the non-monitored or monitored areas of the ED, presenting with chest pain or with shortness of breath. (a) Blood-work ordered. (b) Imaging and ECGs ordered. [CBC, Complete Blood Count; BUN, Blood Urea Nitrogen; CK, Creatinine Kinase; TnI, Troponin I; VBG, Venous Blood Gas; ABG, Arterial Blood Gas; CXR, Chest Radiograph; CT Chest, Chest Computed Tomography; ECG, Electrocardiogram].

Mentions: ED crowding did not appear to influence the proportion of patients who received ED investigations with the exception of more chest computed tomography ordered when the ED was not crowded (9.2% vs. 5.4%, P = 0.01) (Figure 4).


Evaluating the effect of emergency department crowding on triage destination.

O'Connor E, Gatien M, Weir C, Calder L - Int J Emerg Med (2014)

Investigations ordered for high acuity ED patients triaged either to the non-monitored or monitored areas of the ED, presenting with chest pain or with shortness of breath. (a) Blood-work ordered. (b) Imaging and ECGs ordered. [CBC, Complete Blood Count; BUN, Blood Urea Nitrogen; CK, Creatinine Kinase; TnI, Troponin I; VBG, Venous Blood Gas; ABG, Arterial Blood Gas; CXR, Chest Radiograph; CT Chest, Chest Computed Tomography; ECG, Electrocardiogram].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016736&req=5

Figure 4: Investigations ordered for high acuity ED patients triaged either to the non-monitored or monitored areas of the ED, presenting with chest pain or with shortness of breath. (a) Blood-work ordered. (b) Imaging and ECGs ordered. [CBC, Complete Blood Count; BUN, Blood Urea Nitrogen; CK, Creatinine Kinase; TnI, Troponin I; VBG, Venous Blood Gas; ABG, Arterial Blood Gas; CXR, Chest Radiograph; CT Chest, Chest Computed Tomography; ECG, Electrocardiogram].
Mentions: ED crowding did not appear to influence the proportion of patients who received ED investigations with the exception of more chest computed tomography ordered when the ED was not crowded (9.2% vs. 5.4%, P = 0.01) (Figure 4).

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada.

ABSTRACT

Background: Emergency 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.

Methods: This 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 χ(2) and Fisher exact tests.

Results: Over 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.

Conclusions: ED 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.

No MeSH data available.


Related in: MedlinePlus