NEW YORK — The notion that people who come to the emergency department with a less-than-acute health problem are an important cause of overcrowding there is probably not true, Michael J. Schull, M.D., reported at the annual meeting of the Society for Academic Emergency Medicine.
Administrators, politicians, researchers, and physicians often blame low-acuity patients for worsened emergency department (ED) crowding. Plans to reduce ED overcrowding include diverting ED patients with health problems that are not acute to places such as fast-track emergent care centers or primary care clinics.
But it is unknown if non-acutely ill or injured patients are actually responsible for extended lengths of stay for patients with more acute conditions, said Dr. Schull, an emergency physician at the Institute for Clinical Evaluative Sciences at Sunnybrook and Women's College Health Sciences Centre, Toronto.
With his colleagues, Dr. Schull analyzed the assumption that patients with less urgent health problems contribute to ED overcrowding by reviewing consecutive 8-hour intervals in an administrative data set that included all visits to all high-volume EDs in Ontario during 2002–2003.
Overall, the investigators analyzed 4.1 million visits to 110 EDs (16 teaching and 94 community) that had patient volumes ranging from 13,000 to 81,000 per year.
He classified ED patients as in need of acute care if they were admitted to the hospital; at the other end of the spectrum were patients who, arriving at the ED under their own power, were considered not in need of acute care; they received a score of 4 or 5 on the Canadian Triage & Acuity Scale, and were later discharged. All other ED patients were deemed to have health problems in medium need of urgent care.
A patient's entire length of stay in the ED was credited to the 8-hour interval in which he or she arrived, even if the stay extended into the next interval.
Dr. Schull did not find that the EDs were able to reduce the collective length of stay of patients with medium or highly acute problems when fewer patients with non-urgent problems were present.
For every new patient with a non-acute problem, the combined length of stay for patients with medium and highly acute problems increased by only 0.6 minutes.
Each new patient with a highly acute medical problem increased the total length of stay for others with urgent or moderately acute problems by 7 minutes.
“Those [times] are really meaningful when you think of it in terms of what the actual arrival rates of these patients are,” he added.
During a typical 8-hour interval, a median of 16 new low-acuity patients arrived at an ED, resulting in an average increase in the length of stay of medium- and high-acuity patients of 9.7 minutes (4% increase), which is not clinically significant, Dr. Schull said.
A median of three new high-acuity patient arrived at an ED during the 8-hour interval, increasing the mean length of stay of medium- and high-acuity patients by 21 minutes (9%).