Abstract
Background
Although the issues concerning the impact of emergency department (ED) overcrowding
have been the subject of much recent concern, there are few data regarding the effect
of ED census on emergency physician behavior with respect to the decision to admit
patients. Admission rates might either increase or decrease on busy days, when the
system and the physician are under stress.
Study Objective
The purpose of this study was to determine if ED physicians change their admitting
behavior depending on ED census.
Methods
This was a retrospective review of 3 months' data (92 consecutive days, July 9–October
9, 2006) in a community ED with an annual census of approximately 70,000 patients
and an emergency medicine residency program. We defined each of the 92 days to be
either “busy” (> 180 patients seen), “slow” (< 147 patients seen) or “medium” (147–180
patients seen). We then compared the rates of admission to the hospital on the “busy,”
“medium,” and “slow” days. We also compared each attending physician's personal rates
of admission on slow days to his or her rate of admission on medium or busy days.
ED staffing was constant throughout the study period. All comparisons were with chi-squared.
Results
There were 14,969 patients seen in the ED during the 92 study days. On “busy” days,
20.1% of the 3400 patients were admitted to the hospital; on “medium” days, 20.6%
of the 9057 patients were admitted; on “slow” days, 19.7% of the 2512 patients were
admitted. There was no significant association between the level of patient volume
in the ED and rate of admission (p = 0.55). When comparing each of 14 attending physicians to him- or herself, there
was no significant association found between rate of admission and ED census (all
p values > 0.3). All three categories of days, “busy,” “medium,” and “slow” did not
differ in terms of acuity as judged by triage level distribution.
Conclusion
The likelihood of a patient's admission vs. discharge is not affected by ED patient
volume. Furthermore, we found no evidence that an individual physician's admitting
behavior was associated with ED patient volume.
Keywords
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References
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Article info
Publication history
Published online: June 07, 2010
Accepted:
April 11,
2010
Received in revised form:
January 21,
2010
Received:
October 2,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
