Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
CJEM. 2024 Sep;26(9):628-632. doi: 10.1007/s43678-024-00726-z. Epub 2024 Jun 27.
We believe that hospital and emergency department (ED) crowding is exacerbated on Mondays because fewer in-patients are discharged on the weekend. In part 1 of 3 concurrent studies, we documented the number of weekend discharges and the extent of hospital and ED crowding on the days following weekends.
We conducted a data analysis study at The Ottawa Hospital, a major academic health sciences center with two EDs. We created reports of the 18-month period (January 1, 2022-June 30, 2023) regarding the status of in-patients at the two campuses. We compared the total admissions, discharges, and hospital occupancy on weekends (or long weekends), the Monday following weekends (or Tuesday following long weekends), or Tuesdays-Fridays. For these three time periods, we also compared the proportion of ED beds occupied by admitted patients to all ED beds, as well as the proportion of days with > 70% admitted patients housed in the ED at 8:00am.
Our data for 55,692 patients demonstrated that on weekends compared to weekdays, there were almost 50% fewer discharges with the ratio of admissions to discharges averaging 1.16 (95% CI 1.10-1.22). This was accompanied by a 2.4% absolute increase (P < 0.001) in hospital occupancy on Mondays or Tuesdays, often exceeding 100%. Both EDs are particularly crowded on these Mondays and Tuesdays with the proportion of admitted patients to regular ED beds averaging 68%. We observed serious crowding with > 70% occupancy with admitted patients on almost 50% of Mondays.
We have demonstrated that there are much fewer discharges on weekends, and this is associated with significant hospital and ED crowding on Mondays. This blocks safe and timely access to beds for newly arriving patients in the ED. These results should spur Canadian hospitals to evaluate their own data and seek solutions to this important problem.
我们认为周一医院和急诊部（ED）会更加拥挤，因为周末较少有住院病人出院。在三个并行研究的第一部分中，我们记录了周末出院的人数以及周末后几天医院和 ED 的拥挤程度。
我们在渥太华医院进行了一项数据分析研究，该医院是一家拥有两个 ED 的主要学术健康科学中心。我们创建了关于两个校区住院病人状况的 18 个月报告（2022 年 1 月 1 日至 2023 年 6 月 30 日）。我们比较了周末（或长周末）、周末后的周一（或长周末后的周二）或周二至周五的总入院、出院和医院入住率。对于这三个时间段，我们还比较了 ED 占用的住院病人床位比例与 ED 总床位比例，以及早上 8 点 ED 中入住的住院病人比例超过 70%的天数。
我们的数据显示，55692 名患者中，与工作日相比，周末的出院人数减少了近 50%，入院与出院的比例平均为 1.16（95%置信区间 1.10-1.22）。这伴随着周一或周二医院入住率增加 2.4%（P<0.001），通常超过 100%。这两个 ED 在这些周一和周二特别拥挤，住院病人与常规 ED 床位的比例平均为 68%。我们观察到周一几乎有 50%的日子，ED 中入住的病人比例超过 70%，床位严重拥挤。
我们已经证明，周末的出院人数较少，这与周一医院和 ED 严重拥挤有关。这阻碍了新来的 ED 病人安全及时地获得床位。这些结果应该促使加拿大的医院评估自己的数据，并寻求解决这个重要问题的办法。
