Impact of opening a new emergency department on healthcare service and patient outcomes : analyses based on linking ambulance, emergency and hospital databases

Crilly, Julia, O'Dwyer, John, Lind, James, Tippett, Vivienne, Thalib, L., O’Dwyer, M., Keijzers, G., Wallis, M., Bost, N., & Shiels, S. (2013) Impact of opening a new emergency department on healthcare service and patient outcomes : analyses based on linking ambulance, emergency and hospital databases. Internal Medicine Journal, 43(12), pp. 1293-1303.

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Abstract

Background Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload.

Aim To investigate the impact of opening a new ED on patient and healthcare service outcomes.

Methods A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia.

Results Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED.

Conclusions An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a ‘whole of health service area’ approach to solve crowding issues.

Impact and interest:

1 citations in Scopus
1 citations in Web of Science®
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ID Code: 53308
Item Type: Journal Article
Refereed: Yes
Keywords: emergency department, data linkage
DOI: 10.1111/imj.12202
ISSN: 1445-5994
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Emergency Medicine (110305)
Australian and New Zealand Standard Research Classification
Divisions: Current > Research Centres > Centre for Emergency & Disaster Management
Current > Schools > School of Clinical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Copyright Owner: Copyright 2013 The Authors
Copyright Statement: This is the pre-peer reviewed version of the following article: Crilly, J., O'Dwyer, J., Lind, J., Tippett, V., Thalib, L., O'Dwyer, M., Keijzers, G., Wallis, M., Bost, N. and Shiels, S. (2013), Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases. Internal Medicine Journal, 43: 1293–1303. doi: 10.1111/imj.12202, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/imj.12202/abstract
Deposited On: 02 May 2014 02:09
Last Modified: 26 Mar 2015 19:09

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