Association between covid-19 surge and emergency department patient flow and experience

Elsevier

Available online 21 November 2022, 101241

International Emergency NursingAuthor links open overlay panelAbstractBackground

Preparations for Covid-19 in the Netherlands included hospital reconfigurations to increase capacity for the expected surge at the emergency department (ED). We describe patients’ ED length of stay (LOS), crowding and experiences of patients with respiratory complaints during the first Covid-19 peak.

Methods

Retrospective analysis of demand, ED LOS, crowding, and a patient experience survey during a 12-week period in 2020 and similar periods in 2018 and 2019. Crowding levels were calculated using the National ED OverCrowding Scale.

Results

The number of patients with respiratory complaints increased significantly, while total ED numbers were unchanged. Although presentation during the Covid-19 peak and needing hospital admission were associated with a longer ED LOS in patients with respiratory complaints, significantly less crowding occurred compared with the 2018 and 2019 periods. Increased ED LOS was associated with lower patient experience scores.

Conclusion

Advanced warning and its associated preparation within the hospital and the community prevented significant delays in ED throughput during the first Covid-19 peak.

Section snippetsBackground

During the yearly returning influenza outbreaks, many patients present to emergency departments (EDs), potentially causing crowding. Adverse effects of ED crowding include delayed patient care, delayed critical interventions, and decreased patient satisfaction [1], [2], [3], [4]. During the first Covid-19 peak in the Netherlands, early 2020, occurring simultaneously with the influenza season in the Netherlands, we feared substantial crowding. Warned by the Chinese and Italian experiences [5],

Setting

This study was performed in a non-academic, inner-city teaching hospital in The Hague, a seaside city in the Netherlands, home to more than 500,000 people. The 30-bed ED serves as a regional level 1 trauma and acute neurovascular centre, and receives approximately 54,000 adult and paediatric patient visits annually. All patients who present at the ED are registered in the hospital database and subsequently triaged using the Manchester Triage System (MTS) as immediate (level 1), highly urgent

Data analysis

We used descriptive statistics, Chi Square tests, and Kruskal-Wallis tests to compare the three years simultaneously.

To better understand factors associated with ED LOS we created multivariable linear regression models for the general ED population as well as for the patients with respiratory complaints, including study year, age, arrival time, and arrival by ambulance, referral status, triage level, and presenting problem in the models as potential covariates. ED LOS was log-transformed due to

Patient characteristics

During the 12-week study period in 2020, 9274 ED visits were registered, which was similar to the total number of ED visits in the control periods (Table 1). Median age of patients was higher compared with the previous years. Arrivals by ambulance increased significantly and number of self-referrals decreased significantly.

The number of patients with respiratory complaints increased from 763 (in the 2018 study period) to 941 (in the 2020 study period), and the number of self-referrals decreased

Discussion

Our findings show that during the first Covid-19 peak in 2020, ED crowding decreased significantly. This was probably due to the system-wide collective response and hospital preparations which increased resources for the ED, and public health messaging, which may have decreased ED visits in some patient groups.

Conclusions

Advanced warning and its associated preparations within the hospital and the community prevented significant delays in ED throughput during the first Covid-19 peak. The increase in number of patients with respiratory complaints was combined with a drop in some other patient groups. Although presentation during the Covid-19 peak and needing hospital admission were associated with a longer ED LOS in patients with respiratory complaints, significantly less crowding occurred.

Author contributions

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors thank Aad van den Berg, Ellen Berrevoets, Pascale van der Kallen, and Roger van Rietschote for their help with the data collection, and Margje van der Leeuw, who provided language editing.

References (32)Y. Shen et al.Emergency Responses to Covid-19 Outbreak: Experiences and Lessons from a General Hospital in Nanjing

China. Cardiovascular and Interventional Radiology

(2020)

M. Paganini et al.Translating COVID-19 pandemic surge theory to practice in the emergency department: how to expand structure

Disaster medicine and public health preparedness

(2020)

L. Wong et al.Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care

NEJM Catalyst Innovations in Care Delivery

(2020)

WHO WHO. Quality of care [online]. Available at: https://www.who.int/health-topics/quality-of-care#tab=tab_1. Accessed...A. AbdelhadiPatients’ satisfactions on the waiting period at the emergency units. Comparison study before and during COVID-19 pandemic

Journal of Public Health Research

(2021)

K. Hoernke et al.Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal

BMJ open

(2021)

View full text

© 2022 Published by Elsevier Ltd.

留言 (0)

沒有登入
gif