Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-16T02:10:27.540Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding hospital and emergency department congestion: an examination of inpatient admission trends and bed resources

Published online by Cambridge University Press:  21 May 2015

Hannah J. Wong ,
Dante Morra ,
Michael Caesar ,
Michael W. Carter  and
Howard Abrams
Hannah J. Wong
Affiliation:
Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ont. Centre for Research in Health Care Engineering, University of Toronto, Toronto, Ont. Shared Information Management Services, University Health Network, Toronto, Ont.
Dante Morra
Affiliation:
Division of General Internal Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ont. Centre for Innovation in Complex Care, University Health Network, Toronto, Ont.
Michael Caesar
Affiliation:
Centre for Research in Health Care Engineering, University of Toronto, Toronto, Ont.
Michael W. Carter
Affiliation:
Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ont. Centre for Research in Health Care Engineering, University of Toronto, Toronto, Ont.
Howard Abrams*
Affiliation:
Division of General Internal Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ont. Centre for Innovation in Complex Care, University Health Network, Toronto, Ont. Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont.
*
Toronto General Hospital, 200 Elizabeth St., EN 14-216, Toronto ON M5G 2C4; howard.abrams@uhn.on.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Patients in the emergency department (ED) who have been admitted to hospital (inpatient “boarders”) are associated with ED overcrowding. They are also a symptom of a hospital-wide imbalance between demand and supply of resources. We analyzed the trends of inpatient admissions, ED boarding volumes, lengths of stay and bed resources of 3 major admitting services at our teaching institution.

Methods:

We used hospital databases from Jan. 1, 2004, to Dec. 31, 2007, to analyze ED visits that resulted in admission to hospital.

Results:

During the study period, 21 986 ED patients were admitted to hospital. The percentage of cancer-related admissions to the oncology admitting service decreased from 48% in 2004 to 24% in 2007, and admissions to general internal medicine (GIM) increased nearly 2-fold, from 28% in 2004 to 54% in 2007. In addition, GIM admitted about 10% more myocardial infarction and heart failure patients than did cardiology. General internal medicine constituted the majority of ED boarders and had a median boarding length of stay of approximately 15 hours. Inpatient beds on oncology and cardiology services remained static.

Conclusion:

Without bed capacity to admit more patients, our specialty services relied on GIM to serve as a safety net. At the same time, GIM was cited as a main source of ED congestion as their patients occupied more ED beds for longer periods than any other admitting service. The data presented in this study has helped effect positive change within our institution. Other hospitals running at or near capacity and faced with similar ED congestion may apply the methods we used in this study to analyze the cause and nature of their situation.

Résumé

RÉSUMÉObjectif:

On associe les patients ayant été admis à l'hôpital après une consultation à l'urgence (« pensionnaires ») à l'engorgement des urgences. Ils sont également un symptôme d'un déséquilibre important entre l'offre et la demande des ressources dans tout l'hôpital. Nous avons analysé les tendances relativement aux admissions, aux volumes de « pensionnaires » (patients admis occupant une civière à l'urgence), aux durées de séjour et au nombre de lits de 3 grands départements d'hospitalisation à notre établissement hospitalier universitaire.

Méthodes:

Nous avons utilisé les données de l'hôpital, entre le 1er janvier 2004 et le 31 décembre 2007, pour analyser les visites à l'urgence qui ont mené à l'admission à l'hôpital.

Résultats:

Au cours de la période de l'étude, 21 986 patients à l'urgence ont été admis à l'hôpital. Le pourcentage d'hospitalisations liées au cancer au département d'oncologie a diminué entre 2004 et 2007, passant de 48 % à 24 %, et les hospitalisations en médecine interne générale (MIG) ont presque doublé, passant de 28 % en 2004 à 54 % en 2007. En outre, le service de MIG a admis environ 10 % de plus de cas d'infarctus du myocarde et d'insuffisance cardiaque que la cardiologie. La médecine interne générale représentait la majorité des « pensionnaires », qui occupaient une civière à l'urgence pendant une durée médiane d'environ 15 heures. Le nombre de lits en oncologie et en cardiologie est demeuré stable.

Conclusion:

Sans la capacité en lits pour admettre plus de patients, nos départements spécialisés considéraient la MIG comme un filet de sécurité. Parallèlement, la GIM était citée comme une des principales sources de congestion dans les urgences, ses patients occupant plus de lits et plus longtemps que tout autre département d'hospitalisation. Les données présentées dans cette étude ont permis d'apporter des changements positifs au sein de notre établissement. D'autres hôpitaux qui fonctionnent à pleine capacité ou presque et dont les services d'urgence font face à une congestion similaire peuvent appliquer les méthodes que nous avons utilisées dans cette étude pour analyser leur situation et en déterminer la cause.

Keywords

emergency department overcrowdinginpatientcareinternal medicineperformance measurement
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 1 , January 2010 , pp. 18 - 26
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1. Ospina, MB, Bond, K, Schull, M, et al. Key indicators of overcrowding in Canadian emergency departments: a Delphi study. CJEM 2007;9:339–46.Google Scholar
2. Andrulis, DP, Kellermann, A, Hintz, EA, et al. Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med 1991;20:980–6.Google Scholar
3. Fatovich, DM, Nagree, Y, Sprivulis, P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005;22:351–4.Google Scholar
4. Canadian Institute for Health Information. Understanding emergency department wait times: access to inpatient beds and patient flow. Ottawa (ON): The Institute; 2007. Available: http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_792_E&cw_topic=792&cw_rel=AR_1266_E#full (accessed 2009 Sep 23).Google Scholar
5. Richards, JR, Navarro, ML, Derlet, RW. Survey of directors of emergency departments in California on overcrowding. West J Med 2000;172:385–8.Google Scholar
6. Schull, MJ, Slaughter, PM, Redelmeier, DA. Urban emergency department overcrowding: defining the problem and eliminating misconceptions. CJEM 2002;4:76–83.Google Scholar
7. Asplin, BR, Magid, DJ. If you want to fix crowding, start by fixing your hospital. Ann Emerg Med 2007;49:273–4.Google Scholar
8. Forster, AJ. An agenda for reducing emergency department crowding. Ann Emerg Med 2005;45:479–81.Google Scholar
9. DeCoster, C, Roos, NP, Carriere, KC, et al. Inappropriate hospital use by patients receiving care for medical conditions: targeting utilization review. CMAJ 1997;157:889–96.Google Scholar
10. McClaran, J, Tover-Berglas, R, Glass, KC. Chronic status patients in a university hospital: bed-day utilization and length of stay. CMAJ 1991;145:1259–65.Google Scholar
11. Schneider, S, Zwemer, F, Doniger, A, et al. Rochester, New York: a decade of emergency department overcrowding. Acad Emerg Med 2001;8:1044–50.Google Scholar
12. Roberts, DC, McKay, MP, Shaffer, A. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med 2007;51:769–74.Google Scholar
13. McDonald, AJ, Pelletier, AJ, Ellinor, PT, et al. Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004. Ann Emerg Med 2008;51:58–65.Google Scholar
14. McCusker, J, Verdon, J. Do geriatric interventions reduce emergency department visits? A systematic review. J Gerontol A Biol Sci Med Sci 2006;61:53–62.Google Scholar
15. Salvi, F, Morichi, V, Grilli, A, et al. The elderly in the emergency department: a critical review of problems and solutions. Intern Emerg Med 2007;2:292–301.Google Scholar
16. Woods, RA, Lee, R, Ospina, MB, et al. Consultation outcomes in the emergency department: exploring rates and complexity. CJEM 2008;10:25–31.Google Scholar
17. Khare, RK, Powell, ES, Reinhardt, G, et al. Adding more beds to the emergency department or reducing admitted patient boarding times: which has a more significant influence on emergency department congestion? Ann Emerg Med 2008 Google Scholar
18. Olshaker, JS, Rathlev, NK. Emergency department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the emergency department. J Emerg Med 2006;30:351–6.Google Scholar
19. Canadian Association of Emergency Physicians. Joint Position Statement on emergency department overcrowding. CJEM 2001;3:82–8.Google Scholar
20. International classification of diseases. 10th ed., Geneva (CH): World Health Organization; 1992.Google Scholar
21. Abu-Laban, RB. The junkyard dogs find their teeth: addressing the crisis of admitted patients in Canadian emergency departments. CJEM 2006;8:388–91.Google Scholar
22. Moloney, ED, Bennett, K, O’Riordan, D, et al. Emergency department census of patients awaiting admission following reorganisation of an admissions process. Emerg Med J 2006;23:363–7.Google Scholar
23. Ontario Cancer Plan 2008–2011. Toronto (ON): Cancer Care Ontario; 2009. Available: http://ocp.cancercare.on.ca/ (accessed 2009 Sep 23).Google Scholar
24. Schull, MJ, Szalai, JP, Schwartz, B, et al. Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;8:1037–43.Google Scholar
25. Kroneman, M, Siegers, JJ. The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries. Soc Sci Med 2004;59:1731–40.Google Scholar
26. Forster, AJ, Stiell, I, Wells, G, et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003;10:127–33.Google Scholar
27. Hoot, NR, Aronsky, D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008;52:126–36.Google Scholar
28. Hwang, JI. The relationship between hospital capacity characteristics and emergency department volumes in Korea. Health Policy 2006;79:274–83.Google Scholar