Objective: To examine the relationship between hospital and emergency department (ED) occupancy, as indicators of hospital overcrowding, and mortality after emergency admission. Design: Retrospective analysis of 62495 probabilistically linked emergency hospital admissions and death records. Setting: Three tertiary metropolitan hospitals between July 2000 and June 2003. Participants: All patients 18 years or older whose first ED attendance resulted in hospital admission during the study period. Main outcome measures: Deaths on days 2, 7 and 30 were evaluated against an Overcrowding Hazard Scale based on hospital and ED occupancy, after adjusting for age, diagnosis, referral source, urgency and mode of transport to hospital. Results: There was a linear relationship between the Overcrowding Hazard Scale and deaths on Day 7 (r= 0.98; 95% Cl, 0.79-1.00). An Overcrowding Hazard Scale > 2 was associated with an increased Day 2, Day 7 and Day 30 hazard ratio for death of 1.3 (95% Cl, 1.1-1.6), 1.3 (95% Cl, 1.2-1.5) and 1.2 (95% Cl, 1.1-1.3), respectively. Deaths at 30 days associated with an Overcrowding Hazard Scale > 2 compared with one of < 3 were undifferentiated with respect to age, diagnosis, urgency, transport mode, referral source or hospital length of stay, but had longer ED durations of stay (risk ratio per hour of ED stay, 1.1; 95% Cl, 1.1-1.1; P< 0.001) and longer physician waiting times (risk ratio per hour of ED wait, 1.2; 95% Cl, 1.1-1.3; P = 0.01). Conclusions: Hospital and ED overcrowding is associated with increased mortality. The Overcrowding Hazard Scale may be used to assess the hazard associated with hospital and ED overcrowding. Reducing overcrowding may improve outcomes for patients requiring emergency hospital admission.

/pdf/the-association-between-hospital-overcrowding-and-mortality-25f8gvxxc1.pdf

The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments

Numerous reports have questioned the ability of United States emergency departments to handle the increasing demand for emergency services. Emergency department (ED) overcrowding is widespread in US cities and has reportedly reached crisis proportions. The purpose of this review is to describe how ED overcrowding threatens patient safety and public health, and to explore the complex causes and potential solutions for the overcrowding crisis. A review of the literature from 1990 to 2002 identified by a search of the Medline database was performed. Additional sources were selected from the references of the articles identified. There were four key findings. (1) The ED is a vital component of America's health care "safety net". (2) Overcrowding in ED treatment areas threatens public health by compromising patient safety and jeopardising the reliability of the entire US emergency care system. (3) Although the causes of ED overcrowding are complex, the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. (4) Potential solutions for ED overcrowding will require multidisciplinary system-wide support.

https://emj.bmj.com/content/emermed/20/5/402.full.pdf

Emergency department overcrowding in the United States: an emerging threat to patient safety and public health

Discrete Event Simulation (DES) has been widely used in modelling health-care systems for many years and a simple citation analysis shows that the number of papers published has increased markedly since 2004. Over the last 30 years several significant reviews of DES papers have been published and we build on these to focus on the most recent era, with an interest in performance modelling within hospitals. As there are few papers that propose or illustrate general approaches, we classify papers according to the areas of application evident in the literature, discussing the apparent lack of genericity. There is considerable diversity in the objectives of reported studies and in the consequent level of detail: We discuss why specificity dominates and why more generic approaches are rare.

/pdf/discrete-event-simulation-for-performance-modelling-in-2pbcbcdgca.pdf

Discrete event simulation for performance modelling in health care: a review of the literature

Emergency department (ED) overcrowding is a common problem. Despite a widespread belief that low hospital bed availability contributes to ED overcrowding, there are few data demonstrating this effect. Objectives: To identify the effect of hospital occupancy on ED length of stay for admitted patients and patient disposition. Methods: This was an observational study design using administrative data at a 500-bed acute care teaching hospital. All patients presenting to the ED between April 1993 and June 1999 were included in the study. The predictor variable was daily hospital occupancy. Outcome measures included daily ED length of stay for admitted patients, daily consultation rate, and daily admission rate. The models controlled for the average daily age of ED patients and the average daily “arrival density” index, which adjusts for patient volume and clustering of patient arrivals. Results: The average hospital occupancy was 89.7%. On average 155 patients visited the ED daily; 21% were referred to hospital physicians and 19% were admitted. The median ED length of stay for admitted patients was 5 hours 54 minutes (interquartile range 5 hr 12 min to 6 hr 42 min). Daily ED length of stay for admitted patients increased 18 minutes (95% CI = 12 to 24) when there was an absolute increase in occupancy of 10%. The ED length of stay appeared to increase extensively when hospital occupancy exceeded a threshold of 90%. Consultation and admission rates were not influenced by hospital occupancy. Conclusions: Increased hospital occupancy is strongly associated with ED length of stay for admitted patients. Increasing hospital bed availability might reduce ED overcrowding.

https://onlinelibrary.wiley.com/doi/pdf/10.1197/aemj.10.2.127

The effect of hospital occupancy on emergency department length of stay and patient disposition.

We provide a comprehensive overview of the typical decisions to be made in resource capacity planning and control in health care, and a structured review of relevant articles from the field of Operations Research and Management Sciences (OR/MS) for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making.

/pdf/taxonomic-classification-of-planning-decisions-in-health-2eisyi4lp1.pdf

Taxonomic classification of planning decisions in health care: a structured review of the state of the art in OR/MS

Objective: To examine the daily bed requirements arising from the flow of emergency admissions to an acute hospital, to identify the implications of fluctuating and unpredictable demands for emergency admission for the management of hospital bed capacity, and to quantify the daily risk of insufficient capacity for patients requiring immediate admission. Design: Modelling of the dynamics of the hospital system, using a discrete-event stochastic simulation model, which reflects the relation between demand and available bed capacity. Setting: Hypothetical acute hospital in England. Subjects: Simulated emergency admissions of all types except mental disorder. Main outcome measures: The risk of having no bed available for any patient requiring immediate admission; the daily risk that there is no bed available for at least one patient requiring immediate admission; the mean bed occupancy rate. Results: Risks are discernible when average bed occupancy rates exceed about 85%, and an acute hospital can expect regular bed shortages and periodic bed crises if average bed occupancy rises to 90% or more. Conclusions: There are limits to the occupancy rates that can be achieved safely without considerable risk to patients and to the efficient delivery of emergency care. Spare bed capacity is therefore essential for the effective management of emergency admissions, and its cost should be borne by purchasers as an essential element of an acute hospital service. Key messages Acute hospitals which operate at bed occupancy levels of 90% or more face regular bed crises, with the associated risks to patients Management interventions should focus on measures with long term benefits to counteract the growth trend in demand for admission Many initiatives have only a short term effect; they briefly delay the worst effects but do not address the growing mismatch between supply and demand Evaluating management interventions year on year at a single hospital is futile—any effects are swamped by random variations

https://www.bmj.com/content/bmj/319/7203/155.full.pdf

Dynamics of bed use in accommodating emergency admissions: stochastic simulation model

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Michael Place

Author Tools

Chat about Author

Papers

Dynamics of bed use in accommodating emergency admissions: stochastic simulation model