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Intern Med J. 2013 Dec;43(12):1293-303. doi: 10.1111/imj.12202.

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

Author information

  • 1Gold Coast Hospital and Health Service, Southport, Australia; Griffith Health Institute, Griffith University, Gold Coast, Australia; State Wide Emergency Department Network, Brisbane, Australia.

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.

© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

KEYWORDS:

crowding; data linkage; emergency health services; outcomes research

PMID:
23734944
[PubMed - in process]
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