The Department of Emergency Medicine, University of California Davis, Sacramento, CA.
Acad Emerg Med. 2014 May;21(5):504-9. doi: 10.1111/acem.12366.
Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding.
This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures.
The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005).
An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does not appear to be an adequate solution to ED crowding.
急诊部（ED）拥堵是与不良患者结局相关的日益严重的问题。ED 扩张是减少 ED 拥堵的一种方法。本分析的目的是确定 ED 扩张对 ED 拥堵措施的影响。
这是一项回顾性研究，使用了一所学术医疗中心的 ED 从 33 张成人床位扩张到 53 张成人床位前后 11 个月的行政数据。ED 量、人员配备以及住院和入住数据均从电子健康记录（EHR）或行政记录中获得。主要结果是未治疗就离开的患者（LWBT）率，次要结果是住院患者的 ED 总滞留时间。采用多变量稳健线性回归模型来确定 ED 扩张是否与结果指标相关。
扩张前的平均（±SD）每日成人量为 128（±14）例，扩张后的平均（±SD）每日成人量为 145（±17）例。LWBT 患者的百分比保持不变：扩张前为 9.0%，扩张后为 8.3%（差异=0.6%，95%置信区间[CI]为-0.16%至 1.4%）。ED 总滞留时间从 160 小时/天增加到 180 小时/天（差异=20 小时，95%CI 为 8 至 32 小时）。调整每日 ED 量、低危区量、每日等待时间、每日滞留时间和护士人员配备后，LWBT 患者的百分比与 ED 扩张无独立相关性（p=0.053）。调整 ED 后入院、ED 重症监护病房（ICU）入院、择期手术入院、医院入住率、ICU 入住率和运行 ICU 床位数量后，ED 滞留时间的增加与 ED 扩张独立相关（p=0.005）。
ED 床位数的增加与 LWBT 患者的百分比没有显著变化相关，但 ED 滞留时间增加了一个意外的后果。ED 扩张本身似乎不是解决 ED 拥堵的一个充分的解决方案。
