Periods of high crowding at emergency departments (EDs) have a detrimental impact on outcomes, with increased patient mortality, length of hospital stay, and healthcare costs for admitted patients, US study findings indicate.
Benjamin Sun, from Oregon Health and Science University in Portland, and colleagues comment: "Our study provides additional evidence that ED crowding is a marker for worse care for all ED patients who might require hospital admission."
They add in the Annals of Emergency Medicine: "Despite mounting evidence that ED crowding is a health delivery problem that reduces access to emergency care, results in worse quality of care, and leads to lower patient satisfaction, there have subsequently been few systematic actions to address the crisis of ED crowding."
The team examined a total of 995,379 ED visits resulting in admission to 187 nonfederal, acute care hospitals in California, USA, during 2007. ED crowding was determined using the proxy of ambulance diversion hours on the day of admission, excluding episodes of ambulance diversion for reasons other than ED saturation.
On days of high ED crowding, there was a median of 7.1 ambulance diversion hours, compared with no ambulance diversion hours on days of normal ED crowding, and a median of 0.6 hours of ambulance diversion hours overall. Inpatient mortality was significantly greater on high ED crowding days compared with days with normal ED crowding, at 3.9% versus 3.6%.
After adjusted analyses, high ED crowding was associated with a 5.0% increase in the likelihood for inpatient mortality, a 0.8% increase in hospital length of stay, and a 1.0% increase in costs per admission. Excess adverse outcomes attributable to high ED crowding during 2007 included 300 inpatient deaths, 6200 hospital days, and US$ 17 million (€ 13.4 million) in costs.
Further analyses revealed that, in fully adjusted models, high ED crowding was associated with a 9% increased likelihood for in-hospital mortality within 3 days. In addition, the researchers found that being admitted to hospital on days with more than 5 ambulance diversion hours was associated with a 6% increased odds for inpatient death compared with being admitted on days with no ambulance diversion hours.
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