Patterns in emergency-department arrivals and length of stay: Input for visualizations of crowding

TY - JOUR

T1 - Patterns in emergency-department arrivals and length of stay: Input for visualizations of crowding

AU - Hertzum, Morten

PY - 2016

Y1 - 2016

N2 - Crowding is common in emergency departments (EDs) and increases the risk of medical errors, patient dissatisfaction, and clinician stress. The aim of this study is to investigate patterns in patient visits and bottlenecks in ED work in order to discuss the prospects of visualizing such patterns to help manage crowding. We analyze two years of data from a Danish ED for patterns in the patient visits and interview six clinicians from the ED about bottlenecks in their work. The hour of the day explains 50% of the variance in the number of patient arrivals. In addition, there are weekly and yearly patterns in patient arrivals. With respect to the flow of patients through the ED, length of stay increases from low to medium triage levels and then decreases from medium to high triage levels. Also, length of stay increases with patient age. The bottlenecks in the work in the ED relate to patient input (mornings, boom days), patient throughput (staff work hours, linear workflows, manual data entry, overview of patient progress, personal competences), and patient output (no admissions at night, scheduling patient transfers, home transports). The patterns in patient arrivals and length of stay capture factors important to the evolving balance between the demand for ED services and the available resources. Visualization of the patterns, thus, appears a promising tool in managing ED crowding. However, visualizations presuppose reliable data and are expected by the clinicians to be accurate and prognostic. We propose three visualizations.

AB - Crowding is common in emergency departments (EDs) and increases the risk of medical errors, patient dissatisfaction, and clinician stress. The aim of this study is to investigate patterns in patient visits and bottlenecks in ED work in order to discuss the prospects of visualizing such patterns to help manage crowding. We analyze two years of data from a Danish ED for patterns in the patient visits and interview six clinicians from the ED about bottlenecks in their work. The hour of the day explains 50% of the variance in the number of patient arrivals. In addition, there are weekly and yearly patterns in patient arrivals. With respect to the flow of patients through the ED, length of stay increases from low to medium triage levels and then decreases from medium to high triage levels. Also, length of stay increases with patient age. The bottlenecks in the work in the ED relate to patient input (mornings, boom days), patient throughput (staff work hours, linear workflows, manual data entry, overview of patient progress, personal competences), and patient output (no admissions at night, scheduling patient transfers, home transports). The patterns in patient arrivals and length of stay capture factors important to the evolving balance between the demand for ED services and the available resources. Visualization of the patterns, thus, appears a promising tool in managing ED crowding. However, visualizations presuppose reliable data and are expected by the clinicians to be accurate and prognostic. We propose three visualizations.

KW - Faculty of Humanities

KW - emergency department crowding

KW - healthcare

KW - Length of Stay

KW - temporal patterns

KW - visualization

U2 - 10.2174/1875934301609010001

DO - 10.2174/1875934301609010001

M3 - Journal article

SN - 1875-9343

VL - 9

SP - 1

EP - 14

JO - Ergonomics Open Journal

JF - Ergonomics Open Journal

ER -