High emergency department occupancy during disposition decisions decreased the odds of hospital admission (OR 0.93) without increasing the likelihood of 14-day return visits or subsequent hospitalizations.
Observational (n=111,529)
No
Does high ED occupancy reduce the likelihood of hospital admission in adult ED patients?
ED crowding is associated with a reduced likelihood of hospital admission, without an increased likelihood of 14-day return ED visits or subsequent hospitalizations.
Effect estimate: OR 0.93 (95% CI 0.89-0.98)
BACKGROUND: Crowding is a major challenge faced by EDs and is associated with poor outcomes. OBJECTIVES: Determine the effect of high ED occupancy on disposition decisions, return ED visits, and hospitalizations. METHODS: We conducted a retrospective analysis of electronic health records of patients evaluated at an adult, urban, and academic ED over 20 months between the years 2012 and 2014. Using a logistic regression model predicting admission, we obtained estimates of the effect of high occupancy on admission disposition, adjusted for key covariates. We then stratified the analysis based on the presence or absence of high boarder patient counts. RESULTS: Disposition decisions during a high occupancy hour decreased the odds of admission (OR = 0.93, 95% CI: 0.89, 0.98). Among those who were not admitted, high occupancy was not associated with increased odds of return in the combined (OR = 0.94, 95% CI: 0.87, 1.02), with-boarders (OR = 0.96, 95% CI: 0.86, 1.09), and no-boarders samples (OR = 0.93, 95% CI: 0.83, 1.04). Among those who were not admitted and who did return within 14 days, disposition during a high occupancy hour on the initial ED visit was not associated with a significant increased odds of hospitalization in the combined (OR = 1.04, 95% CI: 0.87, 1.24), the with-boarders (OR = 1.12, 95% CI: 0.87, 1.44), and the no-boarders samples (OR = 0.98, 95% CI: 0.77, 1.24). CONCLUSION: ED crowding was associated with reduced likelihood of hospitalization without increased likelihood of 2-week return ED visit or hospitalization. Furthermore, high occupancy disposition hours with high boarder patient counts were associated with decreased likelihood of hospitalization.
Abir et al. (Wed,) conducted a observational in Emergency department visits (n=111,529). High ED occupancy vs. Non-high ED occupancy was evaluated on Hospital admission (OR 0.93, 95% CI 0.89-0.98). High emergency department occupancy during disposition decisions decreased the odds of hospital admission (OR 0.93) without increasing the likelihood of 14-day return visits or subsequent hospitalizations.