Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Abstract

This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 hours. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 hours from ED arrival time and the last 1 h before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3743 (4.3%) returned to the ED within 72 hours. Of the crowding indicators pertaining to total patients, the last 1 h significantly affected decrease in RV (p = 0.0046). Boarding patients were found to increase RV occurrence during the first 1 h (p = 0.0146) and 4 hours (p = 0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 h (p = 0.0166) and 4 hours (p = 0.0335) and evaluating patients during the first 1 h (p = 0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

Keywords: admission; crowding; emergency department; patient satisfaction; quality of healthcare; return visit.

Figure 1

Data processing to reconstruct crowding indicators from an individual patient’s time-related factors. Bars represent the stay of individual patients in the emergency department; the blue bar represents an evaluating phase and the purple bar indicates the boarding phase. If the patient’s stay spanned the time of the 10 min interval, the patient was added to the number of patients at that time. For crowding indicators, the average number of patients during the first 1 h and 4 h and the last 1 h were calculated. For example, in Patient C, the average number of total patients during the first 1 h was (3 + 4 + 5 + 7 + 8 + 8)/6 = 5.8 and the average number of boarding patients during the last 1 h was (3 + 3 + 4 + 4 + 4 + 4)/6 = 3.7.

Figure 2

Study patient disposition. RV, return visit; RVA, return visit with admission; RVNA, return visit with no admission.

Figure 3

The hourly distribution by day of week of patients occupying the emergency department.

Figure 4

Influence of overcrowding in the emergency department on the occurrence of return visit within 72 h. OR, odds ratio; CI, confidence interval; TF4h, total patients during first 4 h; TF1h, total patients during first 1 h; TL1h, total patients during last 1 h; EF4h, evaluating patients during first 4 h; EF1h, evaluating patients during first 1 h; EL1h, evaluating patients during last 1 h; BF4h, boarding patients during first 4 h; BF1h, boarding patients during first 1 h; BL1h, boarding patients during last 1 h.

Figure 5

Influence of overcrowding in the emergency department on the occurrence of return visit with admission within 72 h. OR, odds ratio; CI, confidence interval; TF4h, total patients during first 4 h; TF1h, total patients during first 1 h; TL1h, total patients during last 1 h; EF4h, evaluating patients during first 4 h; EF1h, evaluating patients during first 1 h; EL1h, evaluating patients during last 1 h; BF4h, boarding patients during first 4 h; BF1h, boarding patients during first 1 h; BL1h, boarding patients during last 1 h.