Document Type : Original Article

Authors

1 Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Objective: Standardization of hospital emergency units is a major goal in developed countries to decrease the duration of patients stay in these units. The present study was undertaken to evaluate the prevalence of long-term staying in an emergency ward.
Methods: In the present 2-month cross-sectional study, patients referring to the emergency ward of Imam Hossein hospital were assessed. The patients’ demographic data, including age, the presenting symptoms and signs, reasons for delays, and the final outcome in relation to the location of hospitalization and discharge information were recorded. Data were reported as frequencies and percentages. The results were reported as means and standard deviations using SPSS version 20.
Results: Of 10087 patients admitted into the emergency ward during a 2-month period, 75 patients (0.7%) needed to stay and wait for more than 24 hours. The mean ± standard deviation of the patients’ ages was 62.5 ± 20.2 years, with 60% of the patients being over 60 years of age. The most common reason for overcrowding in the emergency ward was a lack of empty beds, with the need for ICU beds as the most important reason for bed deficiency in 59% of the cases. Nervous system problems were the most common reasons for referring to the emergency unit (41%) in patients under study. Finally, 81% of the patients were hospitalized, 10% died, 7% were discharged based on personal request and 1.3% were transferred to another hospital.
Conclusion: The prevalence of patients staying and waiting in the emergency ward for more than 24 hours was 0.7%. Lack of empty ICU beds was the most important reason for such delays; however, paraclinical problems had no role in these delays which were associated with the death of 10% of patients.

Keywords

1. Saunders CE, Makens PK, Leblanc LJ. Modeling emergency department operations using advanced computer simulation systems. Ann Emerg Med 1989; 18(2): 134-40.
2. Graff L. Overcrowding in the ED: an international symptom of health care system failure. Am J Emerg Med 1999; 17(2): 208-9.
3. Shih FY, Ma MH, Chen SC, Wang HP, Fang CC, Shyu RS, et al. Overcrowding in Taiwan: facts and strategies. Am J Emerg Med 1999; 17(2): 198-202.
4. Miró O. Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 1999; 6(2): 105-7.
5. Gallagher EJ, Lynn S. The etiology of medical gridlock: causes of emergency department overcrowding in New York City. J Emerg Med 1990; 8(6): 785-90.
6. Fernandes CM, Bouthillette F, Raboud JM, Bullock L, Moore CF, Christenson JM, et al. Violence in the emergency department: asurvey of health care workers. CMAJ 1999; 161(10): 1245-8.
7. Morrison L. Abuse of emergency department workers: an inherent career risk or a barometer of the evolving health care system? CMAJ 1999; 161(10): 1262-3.
8. Andrews L. Wellness for Emergency Physicians. Dallas (TX): American College of Emergency Physicians; 1995.
9. Harrison P. Life in the ER: wild nights, mounting stress and mid-40s burnout. CMAJ 1993; 148(9): 1598-600.
10. Lloyd S, Streiner D, Shannon S. Burnout, depression, life and job satisfaction among Canadian emergency physicians. J Emerg Med 1994; 12(4): 559-65.
11. Ontario Hospital Association (OHA), Ontario Ministry of Health (OMA). OHA Region 3: Emergency Services Working Group final report. Published April 1998.
12. Rehmani R. Emergency section and overcrowding in a university hospital of Karachi, Pakistan. J Pak Med Assoc 2004; 54(5): 233-7.
13. Shih FY, Ma MH, Chen SC, Wang HP, Fang CC, Shyu RS, et al. ED overcrowding in Taiwan: facts and strategies. Am J Emerg Med 1999; 17(2): 198-202.
14. Drummond AJ. No room at the inn: overcrowding in Ontario’s emergency departments. CJEM 2002; 4(2): 91-7.
15. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003; 20(5): 402-5.
16. Higginson I. Emergency department crowding.Emerg Med J 2012; 29(6): 437-43.
17. Hatamabadi HR, Alimohammadi H. Reasons for long-term stay in an overcrowded emergency unit in an educational hospital in Tehran. Pajoohandeh 2008; 13(1): 71-5. [In Persian]
18. Taleshi Z. Reasons for staying for more than 24 hours in the Emergency Ward of Imam Hossein hospital [PhD Thesis]. Tehran: Shadid Beheshti University of Medical Sciences; 2008. [In Persian]
19. Hansagi H, Carisson B, Brismar B. The urgency of care need and patient satisfaction of a hospital emergency department. Health Care Manag Rev 1992; 17(2): 71-5.
20. Forouzanfar MM, Hashemi B, Baratloo A, Arhamodolatabadi A, Hatamabadi H, Shahrami A, et al. Discharge against medical advice in emergency department of a general hospital in Tehran. Int Res J Appl Basic Sci 2013; 5(2): 1487-90.
21. Miró O, Sánchez M, Millá J. Hospital mortality and staff workload. Lancet 2000; 356(9238): 1356-7
22. Bindman AB, Grumbach K, Keane D, Rauch L, Luce JM. Consequences of queuing for care at a public hospital emergency department. JAMA 1991; 266(8): 1091-6.
23. Espinosa G, Miró O, Sánchez M, Coll-Vinent B, Millá J. Effects of external and internal factors on emergency department overcrowding. Ann Emerg Med 2002; 39(6): 693-5.
24. 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(2): 127-33.
25. American College of Emergency Physicians: Measures to deal with emergency department overcrowding. Ann Emerg Med 1990; 19(8): 944-5.
26. American College of Emergency Physicians. Emergency department observation units. Ann Emerg Med 1988; 17: 95-6.
27. Kondro W. Relief at a price for emergency wards in Ontario. Lancet 1998; 352(9138): 1451.