1 / 12

Indices of ED crowding

Indices of ED crowding. Stephen Pitts MD, MPH Emory University Department of Emergency Medicine. Crowding: items per m 2. Why measure crowding?. Prevent adverse outcomes in real time Adverse outcomes: delays, morbidity, mortality Proxy outcomes: Waiting time Ambulance diversion

jholloway
Download Presentation

Indices of ED crowding

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Indices of ED crowding Stephen Pitts MD, MPH Emory University Department of Emergency Medicine

  2. Crowding: items per m2

  3. Why measure crowding? • Prevent adverse outcomes in real time • Adverse outcomes: delays, morbidity, mortality • Proxy outcomes: • Waiting time • Ambulance diversion • LWBS rate (Left without being seen) • Alarm bell function: call in backup • Crowding indices that use realtime ED flow tracking • EDWIN: ED work index • READI • NEDOCS: proprietary system • ED work score

  4. Why measure crowding nationally? • Measure system performance • Evaluate temporal trend • EDs are “canary in coalmine” for healthcare system • Compare EDs (benchmarking) • Practice variation = inequity in cost, quality • Marketing = product differentiation

  5. Many other potential indices Ann Emerg Med. 2003;42:824-834

  6. ED occupancy rate:As good as the ED work index (EDWIN)

  7. Calculating occupancy in NHAMCS-EDpublic use data • Not available: • Staffing levels • ED bed availability • Hospital bed availability • Date of visit (only month, day of week) • Available since 2001: • Time of arrival • Length of visit in minutes

  8. National ED arrivals vs. occupancy(2001-2007 NHAMCS-ED surveys combined) Error bars are 95% confidence intervals

  9. occupancy

  10. National ED arrivals vs. occupancy(2001-2007 NHAMCS-ED surveys combined) Mean occupancy Efficiency ratio = 12/38 = 0.32 Mean arrivals Error bars are 95% confidence intervals

  11. Problems with occupancy • No national denominator (# of treatment spaces) • # of spaces probably decreased nationally 2001-2007 • Underestimates crowding trend • Time of discharge = problematic item • Actual ED departure harder to get than time of admission • Underestimates boarding, crowding • Occupancy is an ED-level characteristic • NHAMCS-ED surveys 350+ EDs • ED identity and characteristics are masked • Avg 100 surveys per ED annually • Too few for ED-specific occupancy/efficiency estimate • Solution: proxy for crowding = length of visit • Patient-level analysis

More Related