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Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic

OBJECTIVE: An infectious disease outbreak such as the 2009 influenza pandemic is an unexpected demand shock to hospital emergency departments (EDs). We analysed changes in key performance metrics in (EDs) in Victoria during this pandemic to assess the impact of this demand shock. DESIGN AND SETTING:...

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Autores principales: Sivey, Peter, McAllister, Richard, Vally, Hassan, Burgess, Anna, Kelly, Anne-Maree
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759189/
https://www.ncbi.nlm.nih.gov/pubmed/31550288
http://dx.doi.org/10.1371/journal.pone.0222851
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author Sivey, Peter
McAllister, Richard
Vally, Hassan
Burgess, Anna
Kelly, Anne-Maree
author_facet Sivey, Peter
McAllister, Richard
Vally, Hassan
Burgess, Anna
Kelly, Anne-Maree
author_sort Sivey, Peter
collection PubMed
description OBJECTIVE: An infectious disease outbreak such as the 2009 influenza pandemic is an unexpected demand shock to hospital emergency departments (EDs). We analysed changes in key performance metrics in (EDs) in Victoria during this pandemic to assess the impact of this demand shock. DESIGN AND SETTING: Descriptive time-series analysis and longitudinal regression analysis of data from the Victorian Emergency Minimum Dataset (VEMD) using data from the 38 EDs that submit data to the state’s Department of Health and Human Services. MAIN OUTCOME MEASURES: Daily number of presentations, influenza-like-illness (ILI) presentations, daily mean waiting time (time to first being seen by a doctor), daily number of patients who did-not-wait and daily number of access-blocked patients (admitted patients with length of stay >8 hours) at a system and hospital-level. RESULTS: During the influenza pandemic, mean waiting time increased by up to 25%, access block increased by 32% and did not wait presentations increased by 69% above pre-pandemic levels. The peaks of all three crowding variables corresponded approximately to the peak in admitted ILI presentations. Longitudinal fixed-effects regression analysis estimated positive and statistically significant associations between mean waiting times, did not wait presentations and access block and ILI presentations. CONCLUSIONS: This pandemic event caused excess demand leading to increased waiting times, did-not-wait patients and access block. Increases in admitted patients were more strongly associated with crowding than non-admitted patients during the pandemic period, so policies to divert or mitigate low-complexity non-admitted patients are unlikely to be effective in reducing ED crowding.
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spelling pubmed-67591892019-10-04 Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic Sivey, Peter McAllister, Richard Vally, Hassan Burgess, Anna Kelly, Anne-Maree PLoS One Research Article OBJECTIVE: An infectious disease outbreak such as the 2009 influenza pandemic is an unexpected demand shock to hospital emergency departments (EDs). We analysed changes in key performance metrics in (EDs) in Victoria during this pandemic to assess the impact of this demand shock. DESIGN AND SETTING: Descriptive time-series analysis and longitudinal regression analysis of data from the Victorian Emergency Minimum Dataset (VEMD) using data from the 38 EDs that submit data to the state’s Department of Health and Human Services. MAIN OUTCOME MEASURES: Daily number of presentations, influenza-like-illness (ILI) presentations, daily mean waiting time (time to first being seen by a doctor), daily number of patients who did-not-wait and daily number of access-blocked patients (admitted patients with length of stay >8 hours) at a system and hospital-level. RESULTS: During the influenza pandemic, mean waiting time increased by up to 25%, access block increased by 32% and did not wait presentations increased by 69% above pre-pandemic levels. The peaks of all three crowding variables corresponded approximately to the peak in admitted ILI presentations. Longitudinal fixed-effects regression analysis estimated positive and statistically significant associations between mean waiting times, did not wait presentations and access block and ILI presentations. CONCLUSIONS: This pandemic event caused excess demand leading to increased waiting times, did-not-wait patients and access block. Increases in admitted patients were more strongly associated with crowding than non-admitted patients during the pandemic period, so policies to divert or mitigate low-complexity non-admitted patients are unlikely to be effective in reducing ED crowding. Public Library of Science 2019-09-24 /pmc/articles/PMC6759189/ /pubmed/31550288 http://dx.doi.org/10.1371/journal.pone.0222851 Text en © 2019 Sivey et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sivey, Peter
McAllister, Richard
Vally, Hassan
Burgess, Anna
Kelly, Anne-Maree
Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic
title Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic
title_full Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic
title_fullStr Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic
title_full_unstemmed Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic
title_short Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic
title_sort anatomy of a demand shock: quantitative analysis of crowding in hospital emergency departments in victoria, australia during the 2009 influenza pandemic
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759189/
https://www.ncbi.nlm.nih.gov/pubmed/31550288
http://dx.doi.org/10.1371/journal.pone.0222851
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