Introduction: Surge attendance is an ill-defined, site-dependent concept. Our site is a small rural ED in Ireland with an inpatient bed capacity of 225 beds. It is not unusual now for daily ED attendance to exceed total hospital bed capacity. With an average 20% admission rate, a hospital must achieve a length of stay of less than four days for acute admissions to maintain elective and day care capacity. Careful monitoring of daily, weekly, monthly, and annual attendance trends is required to ensure adequate patient flow through modeling. Methods: Trend analysis of system-generated attendance reports to evaluate 10 years of daily attendance patterns (2014- 2024) and predict potential future bottlenecks. Data examined in Excel. Results: Daily attendance ranged from a low of 1 to a high of 242 in 2024. Average DAILY attendance increased from 93.12 in 2014 to 169.83 in 2024. First day > 130 was 2014, > 150 was 2017, > 170 was 2019, > 190 was 2021, > 210 was 2022, > 240 was 2024. Daily attendance standard deviation was 14.27 in 2014 and 20.52 in 2024. Minimum daily attendance ranged from 48 in 2014 to 108 in 2024. Conclusion: Average daily attendance in 2024 is similar to maximum daily attendance in 2019, which occurred only once that year. In 2015, there were 22 days with attendance > 120, which would have been considered surge attendance at the time. In 2024, there have been 304 days above 120. By comparison, there have been 29 days above 210 attendances in 2024 (Average + 2 standard deviations). In predicting future staffing models required one is required to plan for the daily average + 2 standard deviations to ensure that 95% of the time, there will be adequate staffing. Monitoring trends carefully will ensure departments are adequately staffed and avoid excessive workload and burnout among ED staff.
Molloy et al. (Sun,) studied this question.