Academic journal article Australian Health Review

Expanding Emergency Department Capacity: A Multisite Study

Academic journal article Australian Health Review

Expanding Emergency Department Capacity: A Multisite Study

Article excerpt

Introduction

Approximately 23% of the 7.1 million emergency department (ED) presentations made to Australian public hospitals in 2007-08 were via ambulance.1 Compared with other Australian states and territories, Queensland reported the largest average annual increase in ED presentations (7.7% p.a.) from 2006-07 to 2010-11.2 The utilisation rates of ambulance services in Queens- land have also increased considerably at an average annual rate of 5.4% between 1999-00 and 2009-10 for urgent dispatches.3 Escalating growth in demand from emergency patient services has placed increasing strain on both ambulance and hospital resources.3,4 Negative outcomes, such as ambulance diversion, access block (an ED length of stay (LOS) of >8 h for patients requiring hospital admission5) and increased risk of hospital mortality, as a result of ED and hospital crowding have been reported in Australia and overseas.5-7 Meeting healthcare targets within this environment can be difficult, but is becoming increas- ingly mandated, monitored and reported upon.

Improvements in or expansions of healthcare-related services are required in order to meet the healthcare needs of the com- munity in a safe and sustainable fashion.8-11 In Australia, the Federal Government (through the National Partnership Agree- ment) has committed to provide funding exceeding A$3 billion for new subacute beds, to meet ED and elective surgery targets and for capital and recurrent projects to improve access for patients accessing public hospital services.10 Following a staged annual increase commencing in 2012, it is expected that by 2015 90% of ED presentations should be admitted, transferred or discharged within 4 h, thereby meeting National Emergency Access Targets (NEAT).10 Although descriptions of opening an additional ED or expanding the size and number of beds in an existing ED are noted within the literature,12-16 little research exists evaluating the impact these measures can make to patient, ambulance and health service delivery outcomes.

Expanding ED capacity interacts with overall service provi- sion and patient outcomes. As such, the aim of the present study was to identify the characteristics and predictors of hospital admission and describe outcomes for patients who arrived via ambulance to three Australian public EDs before and after the opening of 41 additional ED beds within a health service.

Methods

Design and setting

The present study was a retrospective comparative cohort study undertaken in three regional public hospitals located in south- east Queensland, Australia. These three hospitals, along with three private hospitals, served a total population of approximately 800 000.17 All three EDs were teaching facilities and treated both adult and paediatric patients. Hospital A had 45 ED beds and 473 hospital beds; Hospital B had 36 ED beds and 290 hospital beds; Hospital C had 41 ED beds and 200 hospital beds. Located approximately 15 km apart, Hospitals A and C shared operational capability; a further 50 km away, Hospital B was slightly more isolated, located midway between two main groups of larger hospitals. The ED at Hospital C opened on 3 September 2007. Seventeen permanent Queensland Ambulance Service stations were located in the direct catchment area, plus a rotary wing retrieval service.

Patients

All patient presentations arriving to three EDs over a 24-month period (3 September 2006-2 September 2008) were included in the linkage of data sources from ambulance, ED and hospital admission. Figure 1 shows the sample inclusion process. Some patient presentations were excluded from the dataset during and following the data cleaning and data linking process due to mode of arrival incorrectly coded (was not via ambulance), no name, no gender and incomplete date and time data. A power calculation showed that the sample size was more than adequate to detect a difference in the primary outcome (hospital admission) and the chance of a Type II error was negligible. …

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