Factors Associated with Occupancy Level in a High- Complexity Emergency Department in Medellín
DOI:
https://doi.org/10.17533/udea.iatreia.307Keywords:
Bed Occupancy, Emergencies, Emergency Service, HospitalAbstract
Introduction: Emergency department (ED) occupancy is influenced by multiple factors, with overcrowding becoming increasingly prevalent. This complex phenomenon is challenging to be measured and negatively impacts patient care delivery.
Objectives: To determine the ED occupancy level at Hospital Pablo Tobón Uribe, Medellin, using the National Emergency Department Overcrowding Study (NEDOCS), analyzing hospital service factors, processes, physical capacity, and human resources.
Methods: An analytical cross-sectional study was conducted. ED occupancy levels were measured continuously over two weeks. Statistical analysis included univariate, bivariate (Chi-square and Spearman correlation), and multivariate (multiple linear regression) analyses.
Results: NEDOCS indicated dangerously overcrowded conditions 98.2% of the time. Correlation between the emergency physician’s perception and NEDOCS scores showed p=0.526. Multivariate model revealed associations with total ED patients (p=0.427), total patients in resuscitation area (p=0.436), and total ED-admitted patients (p<0.01), with an adjusted R2 of 23%.
Conclusions: ED occupancy levels remained dangerously overcrowded during most of the study period. Development of an explanatory model for factors associated with ED occupancy levels was precluded by the constant nature of the outcome variable.
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(1) Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA. A conceptual model of emergency department crowding. Ann Emer Med [Internet]. 2003;42(2):173-180. https://doi.org/10.1067/mem.2003.302
(2) Estrada-Atehortúa AF, Zuluaga-Gómez M. Estrategias para la medición y el manejo de la sobreocupación de los servicios de urgencias de adultos en instituciones de alta complejidad con altos volúmenes de consulta. Revisión de la literatura. Iatreia [Internet]. 2019;33(1):68-77. https://doi.org/10.17533/udea.iatreia.34
(3) Wang H, Robinson RD, Bunch K, Huggins CA, Watson K, Jayswal RD, et al. The inaccuracy of determining overcrowding status by using the National ED Overcrowding Study Tool. Am J Emerg Med [Internet]. 2014;32(10):1230-6. https://doi.org/10.1016/j.ajem.2014.07.032
(4) Badr S, Nyce A, Awan T, Cortes D, Mowdawalla C, Rachoin JS. Measures of Emergency Department Crowding, a Systematic Review. How to Make Sense of a Long List. Open Access Emerg Med [Internet]. 2022;14:5-14. https://doi.org/10.2147/oaem.s338079
(5) O`Connor E, Gatien M, Weir C, Calder L. Evaluating the effect of emergency department crowding on triage destination. Int J Emerg Med [Internet]. 2014;7(16):2-7. https://doi.org/10.1186/1865-1380-7-16
(6) Lauque D, Khalemsky A, Boudi Z, Östlundh L, Xu C, Alsabri M, et al. Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. J Clin Med [Internet]. 2022;12(1):32. https://doi.org/10.3390/jcm12010032
(7) Epstein SK, Huckins DS, Liu SW, Pallin DJ, Sullivan AF, Lipton RI, et al. Emergency department crowding and risk of preventable medical errors. Intern Emerg Med [Internet]. 2012;7(2):173-80. https://doi.org/10.1007/s11739-011-0702-8
(8) Stehman CR, Testo Z, Gershaw RS, Kellogg AR. Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I. West J Emerg Med [Internet]. 2019;20(3):485-494. https://doi.org/10.5811/westjem.2019.4.40970
(9) Austin EE, Blakely B, Tufanaru C, Selwood A, Braithwaite J, Clay-Williams R. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med [Internet]. 2020 Jun 15;28(1):55. https://doi.org/10.1186/s13049-020-00749-2
(10) Stang AS, Crotts J, Johnson DW, Hartling L, Guttmann A. Crowding measures associated with the quality of emergency department care: a systematic review. Acad Emerg Med [Internet]. 2015;22(6):643-56. https://doi.org/10.1111/acem.12682
(11) Weiss SJ, Ernst AA, Sills MR, Quinn BJ, Johnson A, Nick TG. Development of a novel measure of overcrowding in a pediatric emergency department. Pediatr Emerg Care [Internet]. 2007;23(9):641-5. https://doi.org/10.1097/pec.0b013e31814a69e2
(12) Eidstø A, Ylä-Mattila J, Tuominen J, Huhtala H, Palomäki A, Koivistoinen T. Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study. Intern Emerg Med [Internet]. 2024 Jan;19(1):175-181. https://doi.org/10.1007/s11739-023-03392-8
(13) Hoot NR, Zhou C, Jones I, Aronsky D. Measuring and forecasting emergency department crowding in real time. Ann Emerg Med [Internet]. 2007;49(6):747-55. https://doi.org/10.1016/j.annemergmed.2007.01.017
(14) Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernández-Frankelton M, et al. Estimating the Degree of Emergency Department Overcrowding in Academic Medical Centers: Results of the National ED Overcrowding Study (NEDOCS). Acad Emer Med [Internet]. 2004 Jan;11(1):38-50. https://doi.org/10.1197/j.aem.2003.07.017
(15) Garcia-Romero M, Rita-Gáfaro CG, Quintero-Manzano J, Angarita AB. NEDOCS vs subjective evaluation, ¿Is the health personnel of the emergency department aware of its overcrowding? Colomb Med (Cali) [Internet]. 2017 Jun 30;48(2):53-57. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597093/
(16) Castro-Canoa JA, Oliviella-Cohen E, Lineros-Montañez A, Sánchez-Pedraza R. Escala NEDOCS para medir congestión en urgencias: Estudio de validación en Colombia [Tesis]. Bogotá, Colombia; Universidad de Rosario. 2010. https://doi.org/10.48713/10336_2250
(17) Lee YJ, Shin SD, Lee EJ, Cho JS, Cha WC. Emergency Department Overcrowding and Ambulance Turnaround Time. PLoS One [Internet]. 2015;10(6):e0130758. https://doi.org/10.1371/journal.pone.0130758
(18) Giraldo-Hoyos JA, Peña-Arroyave T, Naranjo AF, Lopera YK. Caracterización de los traslados médicos no regulados desde diferentes instituciones prestadoras de salud hacia el Hospital Pablo Tobón Uribe de Medellín, en el año 2017. Med UPB [Internet]. 2019;38(2):114-9. https://doi.org/10.18566/medupb.v38n2.a03
(19) Giunta DH, Pedretti AS, Elizondo CM, Grande-Ratti MF, González-Bernaldo de Quiros F, Waisman GD, et al. Descripción de las características del fenómeno Crowding en la Central de Emergencia de Adultos, en un hospital universitario de alta complejidad: estudio de cohorte retrospectiva. Rev med Chile [Internet]. 2017;145(5):557-63. http://dx.doi.org/10.4067/S0034-98872017000500001
(20) Ilhan B, Kunt MM, Damarsoy FF, Demir MC, Aksu NM. NEDOCS: is it really useful for detecting emergency department overcrowding today? Medicine (Baltimore) [Internet]. 2020 Jul 10;99(28):e20478. https://doi.org/10.1097/md.0000000000020478
(21) Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: A review of strategies to decrease future challenges. J Res Med Sci [Internet]. 2017;22(1):23. https://doi.org/10.4103%2F1735-1995.200277
(22) Raj K, Baker K, Brierley S, Murray D. National Emergency Department Overcrowding Study tool is not useful in an Australian emergency department. Emerg Med Australas [Internet]. 2006;18(3):282–288. https://doi.org/10.1111/j.1742-6723.2006.00854.x
(23) Colella Y, Di Laura D, Borrelli A, Triassi M, Amato F, Improta G. Overcrowding analysis in emergency department through indexes: a single center study. BMC Emerg Med [Internet]. 2022 Nov 18;22(1):181. https://doi.org/10.1186/s12873-022-00735-0
(24) Metrosalud. Alcaldía de Medellín emprende acciones para descongestionar servicios de urgencias [Internet]. 2016. [citado 2021 Ago 28]. Disponible en: http://www.metrosalud.gov.co/sedes/descongestionurgencias
(25) Lowe J, Brown I, Durseti R, Gallegos M, Ribeira R, Pirrotta E, et al. Emergency Department Access During COVID-19: Disparities in Utilization by Race/Ethnicity, Insurance, and Income. West J Emerg Med [Internet]. 2021;22(3):552-60. https://doi.org/10.5811/westjem.2021.1.49279
(26) Lee DD, Jung H, Lou W, Rauchwerger D, Chartier LB, Masood S, et al. The Impact of COVID-19 on a Large, Canadian Community Emergency Department. West J Emerg Med [Internet]. 2021;22(3):572-9. https://doi.org/10.5811/westjem.2021.1.50123
(27) Sandhu P, Shah AB, Ahmad FB, Kerr J, Demeke HB, Graeden E, et al. Emergency Department and Intensive Care Unit Overcrowding and Ventilator Shortages in US Hospitals During the COVID-19 Pandemic, 2020-2021. Public Health Rep [Internet]. 2022;137(4):796-802. https://doi.org/10.1177%2F00333549221091781
(28) Hospital Pablo Tobón Uribe. ¿Quiénes Somos? [Internet]. 2022 [citado 2022 Sep 11]. Disponible en: https://hptu.org/pages/quienes-somos
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