No more winter crisis? Forecasting daily bed requirements for emergency department admissions to hospital.

STUDY HYPOTHESIS

We hypothesized that age, calendar variables, and clinical influenza epidemics may have an impact on the number of daily through-emergency department (ED) hospitalizations. The aim of our study was to elaborate a pragmatic tool to predict the daily number of through-ED hospitalizations.

METHODS

We carried out a prospective-observational study including data from 18 ED located in the Paris metropolitan area. Daily through-ED hospitalizations numbers from 2007 to 2010 were modelized to forecast the year 2011 using a general linear model by age groups (<75-years; ≥75-years) using calendar variables and influenza epidemics as explanatory variables. Lower and higher limits forecast with the 95% confidence interval of each explanatory variable were calculated.

RESULTS

2 741 974 ED visits and 518 857 through-ED hospitalizations were included. We found a negative trend (-2.7%) for hospitalization visits among patients less than 75 years of age and an increased trend (+6.2%) for patients of at least 75 years of age. Calendar variables were predictors for daily hospitalizations for both age groups. Influenza epidemic period was not a predictor for hospitalizations in patients less than 75 years of age; among patients of at least 75 years of age, significant value was found only in models excluding months. When forecasting hospitalizations, 70% for patients less than 75 years of age and 66.8% for patients of at least 75 years of age of daily predicted values were included in the forecast limits.

CONCLUSION

Daily number of emergency hospitalizations could be predicted on a regional basis using calendar variables with a low level of error. Forecasting through-ED hospitalizations requires to differentiate between elderly and younger patients, with a low impact of influenza epidemic periods in elders and absent in youngest patients.