Cargando…
Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden
OBJECTIVES: COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592192/ https://www.ncbi.nlm.nih.gov/pubmed/33115521 http://dx.doi.org/10.1186/s13049-020-00799-6 |
_version_ | 1783601142217834496 |
---|---|
author | af Ugglas, Björn Skyttberg, Niclas Wladis, Andreas Djärv, Therese Holzmann, Martin J. |
author_facet | af Ugglas, Björn Skyttberg, Niclas Wladis, Andreas Djärv, Therese Holzmann, Martin J. |
author_sort | af Ugglas, Björn |
collection | PubMed |
description | OBJECTIVES: COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. METHODS: Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. RESULTS: As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373–399) minutes to 307 (297–317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55–0.99). CONCLUSIONS: It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design. |
format | Online Article Text |
id | pubmed-7592192 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-75921922020-10-28 Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden af Ugglas, Björn Skyttberg, Niclas Wladis, Andreas Djärv, Therese Holzmann, Martin J. Scand J Trauma Resusc Emerg Med Original Research OBJECTIVES: COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. METHODS: Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. RESULTS: As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373–399) minutes to 307 (297–317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55–0.99). CONCLUSIONS: It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design. BioMed Central 2020-10-28 /pmc/articles/PMC7592192/ /pubmed/33115521 http://dx.doi.org/10.1186/s13049-020-00799-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Original Research af Ugglas, Björn Skyttberg, Niclas Wladis, Andreas Djärv, Therese Holzmann, Martin J. Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden |
title | Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden |
title_full | Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden |
title_fullStr | Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden |
title_full_unstemmed | Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden |
title_short | Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden |
title_sort | emergency department crowding and hospital transformation during covid-19, a retrospective, descriptive study of a university hospital in stockholm, sweden |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592192/ https://www.ncbi.nlm.nih.gov/pubmed/33115521 http://dx.doi.org/10.1186/s13049-020-00799-6 |
work_keys_str_mv | AT afugglasbjorn emergencydepartmentcrowdingandhospitaltransformationduringcovid19aretrospectivedescriptivestudyofauniversityhospitalinstockholmsweden AT skyttbergniclas emergencydepartmentcrowdingandhospitaltransformationduringcovid19aretrospectivedescriptivestudyofauniversityhospitalinstockholmsweden AT wladisandreas emergencydepartmentcrowdingandhospitaltransformationduringcovid19aretrospectivedescriptivestudyofauniversityhospitalinstockholmsweden AT djarvtherese emergencydepartmentcrowdingandhospitaltransformationduringcovid19aretrospectivedescriptivestudyofauniversityhospitalinstockholmsweden AT holzmannmartinj emergencydepartmentcrowdingandhospitaltransformationduringcovid19aretrospectivedescriptivestudyofauniversityhospitalinstockholmsweden |