• Wanyi Chen, Benjamin Linthicum, Nilay Tanik Argon, Thomas Bohrmann, Kenneth Lopiano, Abhi Mehrotra, Debbie Travers, and Serhan Ziya.
• University of North Carolina Chapel Hill, Department of Statistics and Operations Research, 318 Hanes Hall, CB #3260, Chapel Hill, NC 27599-3260, United States of America.
• Am J Emerg Med. 2020 Apr 1; 38 (4): 774-779.

BackgroundEmergency department (ED) crowding is a recognized issue and it has been suggested that it can affect clinician decision-making.ObjectivesOur objective was to determine whether ED census was associated with changes in triage or disposition decisions made by ED nurses and physicians.MethodsWe performed a retrospective study using one year of data obtained from a US academic center ED (65,065 patient encounters after cleaning). Using a cumulative logit model, we investigated the association between a patient's acuity group (low, medium, and high) and ED census at triage time. We also used multivariate logistic regression to investigate the association between the disposition decision for a patient (admit or discharge) and the ED census at the disposition decision time. In both studies, control variables included census, age, gender, race, place of treatment, chief complaint, and certain interaction terms.ResultsWe found statistically significant correlation between ED census and triage/disposition decisions. For each additional patient in the ED, the odds of being assigned a high acuity versus medium or low acuity at triage is 1.011 times higher (95% confidence interval [CI] for Odds Ratio [OR] = [1.009,1.012]), and the odds of being assigned medium or high acuity versus low acuity at triage is 1.009 times higher (95% CI for OR = [1.008,1.010]). Similarly, the odds of being admitted versus discharged increases by 1.007 times (95% CI for OR = [1.006,1.008]) per additional patient in the ED at the time of disposition decision.ConclusionIncreased ED occupancy was found to be associated with more patients being classified as higher acuity as well as higher hospital admission rates. As an example, for a commonly observed patient category, our model predicts that as the ED occupancy increases from 25 to 75 patients, the probability of a patient being triaged as high acuity increases by about 50% and the probability of a patient being categorized as admit increases by around 25%.Copyright © 2019. Published by Elsevier Inc.

32 keywords...

hide…