Differentiating properties of occupancy rate and workload to estimate crowding : A Swedish national cross-sectional study
(2022) In Journal of the American college of emergency physicians open 3(1).- Abstract
BACKGROUND: Emergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff-perceived workload as reference.
METHODS: This was a national cross-sectional study in Sweden. EDs provided data on census, treatment beds, staffing, and workload (1-6) at 5 time points. A baseline patient turnover was calculated as the average daily census by treatment beds, denoted turnover per treatment bed (TTB), for each ED. A census ratio (CR), current by daily census, was calculated to adjust for... (More)
BACKGROUND: Emergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff-perceived workload as reference.
METHODS: This was a national cross-sectional study in Sweden. EDs provided data on census, treatment beds, staffing, and workload (1-6) at 5 time points. A baseline patient turnover was calculated as the average daily census by treatment beds, denoted turnover per treatment bed (TTB), for each ED. A census ratio (CR), current by daily census, was calculated to adjust for differences in the number of treatment beds.
RESULTS: Data were returned from 37 (51%) EDs. TTB varied considerably (mean = 4, standard deviation = 1.6; range, 2.1-9.2), and the OR was higher in EDs with TTB >4 compared with ≤4, 0.86 versus 0.43 (0.43; 95% confidence interval [CI], 0.27-0.59), but not workload, 2.75 versus 2.52 (0.23; 95% CI, -0.19 to 0.64). After adjusting for confounders, both TTB (k = -0.3; 95% CI, -0.49 to -0.14) and OR (k = 3.4; 95% CI, 1.76-5.03) affected workload. Correlation with workload was better for CR than for OR (r = 0.75 vs 0.60, respectively).
CONCLUSION: OR is affected by patient-to-treatment bed ratios that differ significantly between EDs and should be accounted for when measuring crowding. CR is not affected by baseline treatment beds and is a better comparable measure of crowding compared with OR in this national comparator study.
(Less)
- author
- Wretborn, Jens
LU
; Ekelund, Ulf
LU
and B Wilhelms, Daniel
- organization
- publishing date
- 2022-02
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of the American college of emergency physicians open
- volume
- 3
- issue
- 1
- article number
- e12648
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85142201598
- pmid:35079734
- ISSN
- 2688-1152
- DOI
- 10.1002/emp2.12648
- language
- English
- LU publication?
- yes
- additional info
- © 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.
- id
- 9bd65ef8-32ea-4f98-b8b5-9a00e8f71836
- date added to LUP
- 2022-09-18 23:03:42
- date last changed
- 2024-06-14 23:29:49
@article{9bd65ef8-32ea-4f98-b8b5-9a00e8f71836, abstract = {{<p>BACKGROUND: Emergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff-perceived workload as reference.</p><p>METHODS: This was a national cross-sectional study in Sweden. EDs provided data on census, treatment beds, staffing, and workload (1-6) at 5 time points. A baseline patient turnover was calculated as the average daily census by treatment beds, denoted turnover per treatment bed (TTB), for each ED. A census ratio (CR), current by daily census, was calculated to adjust for differences in the number of treatment beds.</p><p>RESULTS: Data were returned from 37 (51%) EDs. TTB varied considerably (mean = 4, standard deviation = 1.6; range, 2.1-9.2), and the OR was higher in EDs with TTB >4 compared with ≤4, 0.86 versus 0.43 (0.43; 95% confidence interval [CI], 0.27-0.59), but not workload, 2.75 versus 2.52 (0.23; 95% CI, -0.19 to 0.64). After adjusting for confounders, both TTB (k = -0.3; 95% CI, -0.49 to -0.14) and OR (k = 3.4; 95% CI, 1.76-5.03) affected workload. Correlation with workload was better for CR than for OR (r = 0.75 vs 0.60, respectively).</p><p>CONCLUSION: OR is affected by patient-to-treatment bed ratios that differ significantly between EDs and should be accounted for when measuring crowding. CR is not affected by baseline treatment beds and is a better comparable measure of crowding compared with OR in this national comparator study.</p>}}, author = {{Wretborn, Jens and Ekelund, Ulf and B Wilhelms, Daniel}}, issn = {{2688-1152}}, language = {{eng}}, number = {{1}}, publisher = {{John Wiley & Sons Inc.}}, series = {{Journal of the American college of emergency physicians open}}, title = {{Differentiating properties of occupancy rate and workload to estimate crowding : A Swedish national cross-sectional study}}, url = {{http://dx.doi.org/10.1002/emp2.12648}}, doi = {{10.1002/emp2.12648}}, volume = {{3}}, year = {{2022}}, }