• Ann Emerg Med · Nov 2015

    Multicenter Study

    Emergency Department Crowding and Outcomes After Emergency Department Discharge.

    • Gelareh Z Gabayan, Stephen F Derose, Vicki Y Chiu, Sau C Yiu, Catherine A Sarkisian, Jason P Jones, and Benjamin C Sun.
    • Department of Medicine, University of California, and the Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA. Electronic address: gelareh@gabayan.com.
    • Ann Emerg Med. 2015 Nov 1; 66 (5): 483492.e5483-492.e5.

    Study ObjectiveWe assess whether a panel of emergency department (ED) crowding measures, including 2 reported by the Centers for Medicare & Medicaid Services (CMS), is associated with inpatient admission and death within 7 days of ED discharge.MethodsWe conducted a retrospective cohort study of ED discharges, using data from an integrated health system for 2008 to 2010. We assessed patient transit-level (n=3) and ED system-level (n=6) measures of crowding, using multivariable logistic regression models. The outcome measures were inpatient admission or death within 7 days of ED discharge. We defined a clinically important association by assessing the relative risk ratio and 95% confidence interval (CI) difference and also compared risks at the 99th percentile and median value of each measure.ResultsThe study cohort contained a total of 625,096 visits to 12 EDs. There were 16,957 (2.7%) admissions and 328 (0.05%) deaths within 7 days. Only 2 measures, both of which were patient transit measures, were associated with the outcome. Compared with a median evaluation time of 2.2 hours, the evaluation time of 10.8 hours (99th percentile) was associated with a relative risk of 3.9 (95% CI 3.7 to 4.1) of an admission. Compared with a median ED length of stay (a CMS measure) of 2.8 hours, the 99th percentile ED length of stay of 11.6 hours was associated with a relative risk of 3.5 (95% CI 3.3 to 3.7) of admission. No system measure of ED crowding was associated with outcomes.ConclusionOur findings suggest that ED length of stay is a proxy for unmeasured differences in case mix and challenge the validity of the CMS metric as a safety measure for discharged patients.Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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