Does Emergency Department crowding affect inpatient mortality?
27 januari 2017
The short answer is that it might. While it may not be surprising to you that ED crowding is detrimental to overall patient care, it may surprise you that it could be linked to inpatient mortality. At least a few studies have been looking in that direction.
A 2013 study with almost 1 million ED visits to 187 California hospitals (Sun et al. 2013) found that periods of high ED crowding were associated with increased inpatient mortality, as well as increased length of stay and cost for admitted patients. Another 2015 study (Jo et al. 2015), looking specifically at critically ill patients, found that ED crowding was associated with increased mortality in critically ill patients who were admitted through the ED. A 2015 study conducted in Belgium (Verelst et al. 2015) found that ED crowding was associated with higher inpatient costs, however did not increase mortality.
Solutions for ED crowding have been posed and research is continually ongoing. As a clinician, you should remain cognizant that ED crowding may indirectly affect patients admitted to the hospital. For your practice, keep a focus on rapid but appropriate disposition. In addition, during periods of heavy crowding, if a patient can follow up outpatient with ED return precautions, it may be more appropriate for their care and for the care of other patients already in the hospital. Lastly, when boarding a significant number of patients, transfer to another hospital for admission may result in better patient outcomes.