How ED Crowding Affects Outcomes

How ED Crowding Affects Outcomes

Previous studies have sought to establish a definitive relationship between ED crowding and subsequent mortality, but these investigations often have shortcomings, such as small hospital samples and a lack of adjustment for comorbidities, primary illness diagnoses, and potential hospital-level confounders. In addition, many of these analyses restrict data to specific subgroups, such as patients with acute myocardial infarction, trauma, pneumonia, or critical illness. New Evidence on Inpatient Death In an effort to address these limitations, my colleagues and I conducted a study to assess the effect of ED crowding on patient outcomes. Our study, which was published in the Annals of Emergency Medicine, looked at nearly 1 million admissions through EDs across California. Daily ambulance diversion was the measure of ED crowding. According to our results, ED crowding was associated with 5% greater odds of inpatient death. Patients who were admitted on days with high ED crowding had 0.8% longer hospital stays and 1.0% increased costs per admission. Periods of high ED crowding were associated with 300 excess inpatient deaths, 6,200 hospital days, and $17 million in costs. These findings persisted after extensively adjusting for patient demographics, comorbidities, and primary discharge diagnosis. Although other analyses have reported similar associations, our study generalizes these findings to a larger sample of hospitals and unselected admissions from the ED. ED Crowding: A Marker of Poor Quality Care Our findings support the notion that ED crowding is a marker of poor quality of care. Unfortunately, factors underlying the issue of ED crowding are likely to become worse. As Americans are living longer than ever, this has increased the volume, complexity, and acuity of...

Antimicrobial Stewardship Programs: A Call to Action

Over the past 30 years, many multidrug-resistant organisms have emerged across healthcare settings in the United States. At the same time, there has been a dramatic drop in the development and approval of new antibiotics. “The antimicrobial armamentarium has been depleted,” explains Neil Fishman, MD. “As a result, our ability to treat infectious diseases has been severely compromised. Resistant infections are increasing morbidity and mortality while simultaneously increasing healthcare costs.” Research has shown that a multifaceted approach is required to prevent, detect, and control the emergence of antimicrobial-resistant organisms. This includes ensuring that effective and appropriate therapeutic agents are available and that healthcare settings have the diagnostic capacity to rapidly and reliably detect specific pathogens and their antimicrobial susceptibilities. Promoting better infection prevention and control practices and antimicrobial stewardship programs is important in reducing the burden of infectious diseases, Dr. Fishman says. More healthcare facilities nationwide are launching antimicrobial stewardships because they have the potential to reduce the emergence and transmission of resistant pathogens and decrease antimicrobial resistance. A Joint Position Statement on Antimicrobial Stewardship In the April 2012 issue of Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) published a joint position paper focusing on the need for public policy around the issue of antimicrobial stewardship. SHEA, IDSA, and PIDS have been at the forefront of addressing the need for antimicrobial resistance programs for many years, says Dr. Fishman, co-author of the position paper. “Great efforts are needed to improve prevention and control practices throughout the country.” Key Recommendations...