Effects of staff grade, overcrowding and presentations on emergency department performance: A regression model

Objective To examine the effect of staffing levels by experience of medical officers and overcrowding on ED key performance indicators (KPIs). Methods Presentations to Nepean ED from 6 May to 3 November 2019 were examined. Staff were designated either Fellows of the Australasian College for Emergency Medicine (FACEMs), non‐FACEM senior decision‐makers (SDMs), non‐senior decision‐makers greater than 2 years postgraduate (non‐SDMs) and junior medical officers up to 2 years postgraduate (JMOs). The number of admitted patients boarded in the ED waiting for a ward bed at 8 am was used as a marker for overcrowding. Multivariable regression analysis was performed using staffing levels, number of admissions at 8 am and total presentations as the independent variables and various ED KPIs as the dependent variables. Results FACEM and SDM had a significant effect on most ED KPIs, with the effect of FACEM consistently larger than the effect of SDM. There was minimal effect on performance by non‐SDM and JMO staffing. There was significant effect of overcrowding as measured by the number of admitted patients in ED at 8 am on most ED KPIs. Almost no variables had an effect on Emergency Treatment Performance (4‐h target) for admitted patients, suggesting poor performance was caused by factors outside of the ED. Conclusion Increasing numbers of FACEM and non‐FACEM SDM, but not junior staff, and a reduction in overcrowding as measured by the number of admitted patients boarded in the ED at 8 am, were associated with improvements in the ED performance. A multivariable regression analysis was performed using numbers of FACEM, non‐FACEM senior decision‐makers (SDM), non‐senior decision makers (non‐SDM) and junior medical officers (JMO), number of admissions waiting for a ward bed in the ED at 8 am and total presentations as the independent variables and various ED KPIs as the dependent variables. Increasing numbers of FACEM and non‐FACEM SDM, but not junior staff, and a reduction in overcrowding as measured by the number of admitted patients boarded in the ED at 8 am, were associated with improvements in ED performance.