Expanding emergency department capacity: a multisite study
Julia L. Crilly A B I , Gerben B. Keijzers A B C , Vivienne C. Tippett D , John A. O’Dwyer A B E , Marianne C. Wallis A B F , James F. Lind A B , Nerolie F. Bost A , Marilla A. O’Dwyer E and Sue Shiels G
+ Author Affiliations
- Author Affiliations
A Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: gerben.keijzers@health.qld.gov.au; james.lind@health.qld.gov.au; nerolie.bost@health.qld.gov.au
B G16, c/o Centre for Health Practice Innovation, Griffith Health Institute, Gold Coast Campus, Griffith University, Parklands Drive, Qld 4222, Australia.
C School of Medicine, Bond University, Gold Coast, University Drive, Qld 4229, Australia.
D Faculty of Health, School of Clinical Sciences, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia. Email: Vivienne.tippett@qut.edu.au
E Australian eHealth Research Centre, Level 5, UQ Health Sciences Building 901/16, Royal Brisbane & Women’s Hospital, Herston, Qld 4029, Australia. Email: john.odwyer@csiro.au; marilla.odwyer@gmail.com
F University of Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, Qld 4556, Australia. Email: mwallis@usc.edu.au
G Logan Hospital, Queensland Health, Corner Armstrong and Loganlea Roads, Meadowbrook, Qld 4131, Australia. Email: sue.shiels@health.qld.gov.au
H Nursing Education and Research Unit, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia.
I Corresponding author. Email: julia.crilly@health.qld.gov.au
Australian Health Review 38(3) 278-287 https://doi.org/10.1071/AH13085
Submitted: 29 April 2013 Accepted: 27 January 2014 Published: 29 May 2014
Journal Compilation © AHHA 2014
Abstract
Objectives The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area.
Methods The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission.
Results Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1–3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses.
Conclusions Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered.
Additional keywords: ambulance, data linkage, outcomes, service delivery.
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