Comparing the Effect of Throughput and Output Factors on Emergency Department Crowding: A Retrospective Observational Cohort Study - 19/09/18
, Dan Chateau, PhD a, c, Alecs Chochinov, MD, FRCPC b, Ellen Weber, MD e, Jennifer E. Enns, PhD a, Shelley Derksen, MSc a, Joykrishna Sarkar, MSc a, Michael Schull, MD, MSc f, Ricardo Lobato de Faria, MBBCh, CCFP b, g, Alan Katz, MBChB, MSc a, c, d, Ruth-Ann Soodeen, MSc aAbstract |
Study objective |
This study compares how throughput and output factors affect emergency department (ED) median waiting room time.
Methods |
Administrative health care use records were used to identify all daytime (8 am to 8 pm) visits made to adult EDs in Winnipeg, Canada, between April 1, 2012, and March 31, 2013. First, we measured the waiting room time (from patient registration until transfer into the ED) of each index visit (incoming patient). We then linked each index visit to a group of existing patients surrounding it and counted the number of existing patients engaged in throughput processes (radiographs, computed tomography [CT] scans, advanced diagnostic tests) and one output process (waiting to be hospitalized). Regression analysis was used to measure how strongly each factor uniquely affected incoming patient median waiting room time, stratified by the acuity level.
Results |
Analyses were performed on 143,172 index visits. On average, 153.4 radiographs and 48.5 CT scans were conducted daily, whereas 45.3 patients were admitted daily to hospital. Median waiting room time was shortest (8.0 minutes) for the highest-acuity index visits and was not influenced by these throughput or output factors. For all other index visits, median waiting room time was associated strongly with the number of existing patients receiving radiographs, and, to a lesser extent, with the number of existing patients receiving CT scans and waiting for hospital admission.
Conclusion |
Both throughput and output factors affect how long newly arriving ED patients remain in the waiting room. This suggests that a range of strategies may help to reduce ED wait time, each requiring stronger ED and hospital partnerships.
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| Please see page 411 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Daniel A. Handel, MD, MBA |
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| Author contributions: MBD, DC, SD, JS, RLF, and R-AS were involved in the conception and design of the study. MBD, DC, SD, and JS were involved in data analysis. AC, EW, JEE, MS, AK, and R-AS were involved in the interpretation and discussion of results. MBD, AC, EW, and JEE contributed to drafting the article, and all authors contributed to revisions. All authors approved the final version of the article. MBD takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). This research was funded by a grant from the Manitoba government. Dr. Chochinov is the director of emergency medicine in the Winnipeg Regional Health Authority, where the study was performed. Dr. Lobato de Faria works as an emergency physician in this regional health authority. |
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| The funders had no input in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. All authors are independent of the Manitoba government. |
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Vol 72 - N° 4
P. 410-419 - octobre 2018 Retour au numéro
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