Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases. Issue 12 (December 2013)

• Record Type: Journal Article
• Authors: Crilly, J.; O'Dwyer, J.; Lind, J.; Tippett, V.; Thalib, L.; O'Dwyer, M.; Keijzers, G.; Wallis, M.; Bost, N.; Shiels, S.
• Is Part Of: Internal medicine journal. Volume 43:Issue 12(2013)
• Page Start: 1293
• Page End: 1303
• Publication Date: 2013-12
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12202
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12202-sec-0001" sec-type="section"> <title>Background: </title> <p>Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload.</p> </sec> <sec id="imj12202-sec-0002" sec-type="section"> <title>Aim</title> <p>To investigate the impact of opening a new ED on patient and healthcare service outcomes.</p> </sec> <sec id="imj12202-sec-0003" sec-type="section"> <title>Methods</title> <p>A 24‐month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia.</p> </sec> <sec id="imj12202-sec-0004" sec-type="section"> <title>Results</title> <p>Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre‐existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, <italic>P</italic> < 0.001; Hospital B PRE: 10 min, POST: 15 min, <italic>P</italic> < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, <italic>P</italic> < 0.001; Hospital B PRE: 182 min, POST: 210 min, <italic>P</italic> < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, <italic>P</italic> < 0.001; Hospital B PRE: 23%, POST: 40%, <italic>P</italic> < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED.</p> </sec> <sec id="imj12202-sec-0005" sec-type="section"> <title>Conclusions</title> <p>An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre‐existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues.</p> </sec> </abstract>