Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments.

Title

Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments.

Creator

Dark C;Canellas M; Mangira C; Jouriles N; Simon EL

Publisher

Journal of the American College of Emergency Physicians Open

Date

2020
2020-12

Description

OBJECTIVE: Our investigation compared throughput metrics and utilization measures for freestanding emergency departments (FSEDs) versus hospital-based emergency departments (HBEDs) of similar volumes in the United States. METHODS: This study is a cross sectional survey of 183 FSEDs and 317 HBEDs located across the United States using the Emergency Department Benchmarking Alliance (EDBA) Database. We measured common emergency department (ED) throughput metrics. Primary outcomes included overall length of stay, length of stay for admitted, and length of stay for treated and released patients. Outcomes were weighted based on the proportion of ED volume per facility as per a prior pilot study. Multiple linear regression analysis was used to adjust for measured differences between FSEDs and HBEDs. The variables that were controlled for in regression analysis included geographic location of the ED (urban, suburban, and rural), percent of high acuity capacity, ED volume, percentage of patients arriving via emergency medical services (EMS), and percentage of pediatric patients. RESULTS: Nationally, the median length of stay in minutes (104.2 vs 140.0), length of stay for treated and released patients (98.6 vs 122.9), door-to-bed (4.0 vs 8.0), door-to-doctor (11.0 vs 16.0), percentage of patients admitted through the ED (4.0 vs 11.0), and percentage of patients leaving the ED without being seen (LWBS) (0.9 vs 1.5), were significantly lower at FSEDs compared to HBEDs (P < 0.0001 for all comparisons). Length of stay for admitted patients (265.9 vs 241.8) and median boarding time (96.8 vs. 71.3) were significantly lower in HBEDs compared to FSEDs. X-ray, computed tomography, and ECG utilization per 100 patients was significantly lower at the FSEDs compared to HBEDs. Multiple linear regression analysis demonstrated that the length of stay for treated and released patients was 8.67 minutes shorter for FSEDs as compared to HBEDs (95% confidence interval [CI] = -1.4 to -16.0). The length of stay for admitted patients was 44 minutes longer for FSEDs as compared to HBEDs (95% CI = 25.5 to 63.0). CONCLUSIONS: In this study of similarly sized EDs in the United States, throughput metrics for FSEDs tended to be significantly shorter from the arrival of the patient until their departure, except for patients requiring hospital admission. For measures favoring FSEDs, throughput times range from 20%-50% shorter than HBEDs.

Identifier

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

Search for Full-text

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Pages

1297-1303

Issue

6

Volume

1

ISSN

2688-1152

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of Emergency Medicine

Update Year & Number

January 2021 List

Affiliated Hospital

Summa Health Akron City Hospital

Citation

Dark C;Canellas M; Mangira C; Jouriles N; Simon EL, “Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments.,” NEOMED Bibliography Database, accessed November 27, 2021, https://neomed.omeka.net/items/show/11516.

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