Stranded on emergency isle: Modeling competition for cardiac services using survival analysis

Patients with cardiovascular disease (CVD) consume a large proportion of inpatient, procedural and emergency services within United States health care system. These patients are major contributors to the steadily increasing demand for health care services nationwide. Unfortunately, economic and legislative factors have resulted in concurrent reductions in hospital system capacity. The resulting imbalance has fallen directly on to the shoulders of emergency departments (ED) in the form of boarding. Boarding refers to the act of holding admitted patients in the ED until an inpatient bed becomes available. Boarding is a barrier to efficient throughput, a major contributor to ED overcrowding and a threat to patient safety. Patients with CVD often use the ED as an entry point to the hospital system. These patients frequently experience long boarding times as a result of hospital wide competition for inpatient resources. The objective of this study is to use survival analysis to determine how demand from competing cardiology admission sources affects access to ED patients requiring inpatient cardiac care. The model reflects bed management policies of the division of cardiology and demonstrates how variability in demand for cardiac services (i.e., surgical, catheterization, telemetry, intensive care) affects ED boarding time for cardiac patients.