2013, Number 4
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Gac Med Mex 2013; 149 (4)
Modified overcrowd index in emergency room
Polanco-González C, Castañón-González JA, Buhse T, Samaniego-Mendoza JL, Arreguín-Nava R, Villanueva-Martínez S
Language: Spanish
References: 19
Page: 417-424
PDF size: 87.56 Kb.
ABSTRACT
Introduction: Overcrowd of emergency rooms affects efficiency and quality of medical care.
Objectives: To describe the
mathematical-computational system modified overcrowd index which measures in real time and in four levels of warnings
(non crowded, crowded, overcrowded and extreme overcrowded) emergency room saturation in a network of hospitals, from
only seven simple variables (number of available beds, physicians and nurses, number of patients in the waiting room, in
medical consultation and admitted for further evaluation, as well as number of critically ill patients admitted).
Materials and
methods: The modified overcrowd index was exhaustively tested with 245,280 virtual transactions from seven hospitals in
an uninterrupted schedule basis simulating hourly surveillance for four years.
Results: From 224 episodes of overcrowd,
216 (97%) where correctly identified and verified by the network of hospitals warnings, its time series also provided
useful information about available personnel and resource distribution within the hospital network.
Conclusions:
Modified overcrowd index is an efficient tool detecting emergency room overcrowd outbreaks in a network of hospitals.
REFERENCES
Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;5:402-5.
Bagust A, Place M, Posnett JW. Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ. 1999;319:155-8.
Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007;386:1-32.
Barkhordarian A, Hacker B, Chiappelli F. Dissemination of evidencebased standards of care. Bioinformation. 2011;7:315-9.
Santos-Burgoa C, Rodríguez-Cabrera L, Rivero L, et al. Implementation of Mexico’s Health Promotion Operational Model. Prev Chronic Dis. 2009;6:A32.
Moskiop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency department crowding. Part 2: Barriers to reform and strategies to overcome them. Ann Emerg Med. 2009;53:612-7.
Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency department crowding. Part 1: Concept, causes, and moral consequences. Ann Emerg Med. 2009;53:605-11.
Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA Jr. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42:173-80.
Polanco C, Samaniego JL. Detection of selective cationic amphipatic antibacterial peptides by Hidden Markov models. Acta Biochim Pol. 2009;56:167-76.
Forster AJ, Stiell I, Wells G, Lee AJ, Van Walraven C. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med. 2003;10:127-33.
McCabe JB. Emergency department overcrowding: a national crisis. Acad Med. 2001;76:672-4.
Rathlev NK, Chessare J, Olshaker J, et al. Time series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med. 2007;49:265-71.
Schull MJ, Kiss A, Szalai JP. The effect of low-complexity patients on emergency department waiting times. Ann Emerg Med. 2007;49: 257-64.
Newton MF, Keirns CC, Cunningham R, Hayward RA, Stanley R. Uninsured adults presenting to US emergency departments: assumptions vs. data. JAMA. 2008;300:1914-24.
Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35:63-8.
Derlet R, Richards J, Kravitz R. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med. 2001;8:151-5.
Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA. 1991;266:1085-90.
Flisser-Steinbruch A, Rohde-Einhaus F, Del Río-Rizo JL, et al. The Dr. Manuel Gea General Hospital: past, present, and future. Gac Med Mex. 2004;140:163-97.
McConnell KJ, Richards CF, Daya M, Bernell SL, Weathers CC, Lowe RA. Effect of increased ICU capacity on emergency department length of stay and ambulance diversion. Ann Emerg Med. 2005;45:471-8.