The influence of crowding on clinical practice in the emergency department
This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED). This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED...
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| Veröffentlicht in: | The American journal of emergency medicine 2018-01, Vol.36 (1), p.56-60 |
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| container_title | The American journal of emergency medicine |
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| creator | Chiu, I-Min Lin, Yan-Ren Syue, Yuan-Jhen Kung, Chia-Te Wu, Kuan-Han Li, Chao-Jui |
| description | This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED).
This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED occupancy status, determined by the number of patients staying during their time of visit, was used to measure crowding, grouped into four quartiles, and analyzed in reference to the clinical practice. The clinical practices included decision-making time, patient length of stay, patient disposition, and use of laboratory examinations and computed tomography (CT).
The four quartiles of occupancy statuses determined by the number of patients staying during their time of visit were 62. Comparing >62 and |
| doi_str_mv | 10.1016/j.ajem.2017.07.011 |
| format | Article |
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This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED occupancy status, determined by the number of patients staying during their time of visit, was used to measure crowding, grouped into four quartiles, and analyzed in reference to the clinical practice. The clinical practices included decision-making time, patient length of stay, patient disposition, and use of laboratory examinations and computed tomography (CT).
The four quartiles of occupancy statuses determined by the number of patients staying during their time of visit were <24, 24–39, 39–62, and >62. Comparing >62 and <24 ED occupancy statuses, the physicians' decision-making time and patients' length of stay increased by 0.3h and 1.1h, respectively. The percentage of patients discharged from the ED decreased by 15.5% as the ED observation, general ward, and intensive care unit admissions increased by 10.9%, 4%, and 0.7%, respectively. CT and laboratory examination slightly increased in the fourth quartile of ED occupancy.
Overcrowding in the ED might increase physicians' decision-making time and patients' length of stay, and more patients could be admitted to observation units or an inpatient department. The use of CT and laboratory examinations would also increase. All of these could lead more patients to stay in the ED.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2017.07.011</identifier><identifier>PMID: 28705743</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Clinical decision making ; Computed tomography ; Crowding ; Decision making ; Emergency department ; Emergency department crowding ; Emergency medical care ; Emergency medical services ; Emergency physicians ; Emergency services ; Mortality ; Overcrowding ; Patient satisfaction ; Physicians ; Training ; Trauma</subject><ispartof>The American journal of emergency medicine, 2018-01, Vol.36 (1), p.56-60</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-9974035ff6f7002cd8a2179530aee8c443af5e93c730faa1f33ae4f31fec3e9a3</citedby><cites>FETCH-LOGICAL-c384t-9974035ff6f7002cd8a2179530aee8c443af5e93c730faa1f33ae4f31fec3e9a3</cites><orcidid>0000-0002-7777-2215</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675717305399$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28705743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chiu, I-Min</creatorcontrib><creatorcontrib>Lin, Yan-Ren</creatorcontrib><creatorcontrib>Syue, Yuan-Jhen</creatorcontrib><creatorcontrib>Kung, Chia-Te</creatorcontrib><creatorcontrib>Wu, Kuan-Han</creatorcontrib><creatorcontrib>Li, Chao-Jui</creatorcontrib><title>The influence of crowding on clinical practice in the emergency department</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED).
This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED occupancy status, determined by the number of patients staying during their time of visit, was used to measure crowding, grouped into four quartiles, and analyzed in reference to the clinical practice. The clinical practices included decision-making time, patient length of stay, patient disposition, and use of laboratory examinations and computed tomography (CT).
The four quartiles of occupancy statuses determined by the number of patients staying during their time of visit were <24, 24–39, 39–62, and >62. Comparing >62 and <24 ED occupancy statuses, the physicians' decision-making time and patients' length of stay increased by 0.3h and 1.1h, respectively. The percentage of patients discharged from the ED decreased by 15.5% as the ED observation, general ward, and intensive care unit admissions increased by 10.9%, 4%, and 0.7%, respectively. CT and laboratory examination slightly increased in the fourth quartile of ED occupancy.
Overcrowding in the ED might increase physicians' decision-making time and patients' length of stay, and more patients could be admitted to observation units or an inpatient department. The use of CT and laboratory examinations would also increase. All of these could lead more patients to stay in the ED.</description><subject>Clinical decision making</subject><subject>Computed tomography</subject><subject>Crowding</subject><subject>Decision making</subject><subject>Emergency department</subject><subject>Emergency department crowding</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency physicians</subject><subject>Emergency services</subject><subject>Mortality</subject><subject>Overcrowding</subject><subject>Patient satisfaction</subject><subject>Physicians</subject><subject>Training</subject><subject>Trauma</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kE1LxDAQhoMo7vrxBzxIwYuXrpkm2bTgRcRPBC96DjGdrCn9MmmV_fem7OrBgzAwl-d9mXkIOQG6AArLi2qhK2wWGQW5oHEAdsgcBMvSHCTskjmVTKRLKeSMHIRQ0UhwwffJLMslFZKzOXl8ecfEtbYesTWYdDYxvvsqXbtKujYxtWud0XXSe20GZyY0GWICG_SrmFgnJfbaDw22wxHZs7oOeLzdh-T19ubl-j59er57uL56Sg3L-ZAWheSUCWuXVlKamTLXGchCMKoRc8M501ZgwYxk1GoNljGN3DKwaBgWmh2S801v77uPEcOgGhcM1rVusRuDgiIaKbgQIqJnf9CqG30br4uUjGYyEEWksg0VXw_Bo1W9d432awVUTaZVpSbTajKtaByAGDrdVo9vDZa_kR-1EbjcABhdfDr0Khg3SS6dRzOosnP_9X8DM1eOZQ</recordid><startdate>201801</startdate><enddate>201801</enddate><creator>Chiu, I-Min</creator><creator>Lin, Yan-Ren</creator><creator>Syue, Yuan-Jhen</creator><creator>Kung, Chia-Te</creator><creator>Wu, Kuan-Han</creator><creator>Li, Chao-Jui</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7777-2215</orcidid></search><sort><creationdate>201801</creationdate><title>The influence of crowding on clinical practice in the emergency department</title><author>Chiu, I-Min ; Lin, Yan-Ren ; Syue, Yuan-Jhen ; Kung, Chia-Te ; Wu, Kuan-Han ; Li, Chao-Jui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-9974035ff6f7002cd8a2179530aee8c443af5e93c730faa1f33ae4f31fec3e9a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Clinical decision making</topic><topic>Computed tomography</topic><topic>Crowding</topic><topic>Decision making</topic><topic>Emergency department</topic><topic>Emergency department crowding</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency physicians</topic><topic>Emergency services</topic><topic>Mortality</topic><topic>Overcrowding</topic><topic>Patient satisfaction</topic><topic>Physicians</topic><topic>Training</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chiu, I-Min</creatorcontrib><creatorcontrib>Lin, Yan-Ren</creatorcontrib><creatorcontrib>Syue, Yuan-Jhen</creatorcontrib><creatorcontrib>Kung, Chia-Te</creatorcontrib><creatorcontrib>Wu, Kuan-Han</creatorcontrib><creatorcontrib>Li, Chao-Jui</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chiu, I-Min</au><au>Lin, Yan-Ren</au><au>Syue, Yuan-Jhen</au><au>Kung, Chia-Te</au><au>Wu, Kuan-Han</au><au>Li, Chao-Jui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The influence of crowding on clinical practice in the emergency department</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2018-01</date><risdate>2018</risdate><volume>36</volume><issue>1</issue><spage>56</spage><epage>60</epage><pages>56-60</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED).
This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED occupancy status, determined by the number of patients staying during their time of visit, was used to measure crowding, grouped into four quartiles, and analyzed in reference to the clinical practice. The clinical practices included decision-making time, patient length of stay, patient disposition, and use of laboratory examinations and computed tomography (CT).
The four quartiles of occupancy statuses determined by the number of patients staying during their time of visit were <24, 24–39, 39–62, and >62. Comparing >62 and <24 ED occupancy statuses, the physicians' decision-making time and patients' length of stay increased by 0.3h and 1.1h, respectively. The percentage of patients discharged from the ED decreased by 15.5% as the ED observation, general ward, and intensive care unit admissions increased by 10.9%, 4%, and 0.7%, respectively. CT and laboratory examination slightly increased in the fourth quartile of ED occupancy.
Overcrowding in the ED might increase physicians' decision-making time and patients' length of stay, and more patients could be admitted to observation units or an inpatient department. The use of CT and laboratory examinations would also increase. All of these could lead more patients to stay in the ED.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28705743</pmid><doi>10.1016/j.ajem.2017.07.011</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-7777-2215</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Clinical decision making Computed tomography Crowding Decision making Emergency department Emergency department crowding Emergency medical care Emergency medical services Emergency physicians Emergency services Mortality Overcrowding Patient satisfaction Physicians Training Trauma |
| title | The influence of crowding on clinical practice in the emergency department |
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