Study objective

To examine whether hospital occupancy was associated with increased testing and treatment during emergency department (ED) evaluations, resulting in reduced admissions.

Methods

We analyzed the electronic health records of an urban academic ED. We linked data from all ED visits from October 1, 2010, to May 29, 2015, with daily hospital occupancy (inpatients/total staffed beds). Outcome measures included the frequency of laboratory testing, advanced imaging, medication administration, and hospitalizations. We modeled each outcome using multivariable negative binomial or logistic regression, as appropriate, and examined their association with daily hospital occupancy quartiles, controlling for patient and visit characteristics. We calculated the adjusted outcome rates and relative changes at each daily hospital occupancy quartile using marginal estimating methods.

Results

We included 270,434 ED visits with a mean patient age of 48.1 (standard deviation 19.8) years; 40.1% were female, 22.8% were non-Hispanic Black, and 51.5% were commercially insured. Hospital occupancy was not associated with differences in laboratory testing, advanced imaging, or medication administration. Compared with the first quartile, the third and fourth quartiles of daily hospital occupancy were associated with decreases of 1.5% (95% confidence interval [CI] −2.9 to −0.2; absolute change −0.6 percentage points [95% CI −1.2 to −0.1]) and 4.6% (95% CI −6.0 to −3.2; absolute change −1.9 percentage points [95% CI −2.5 to −1.3]) in hospitalizations, respectively.

Conclusion

The lack of association between hospital occupancy and laboratory testing, advanced imaging, and medication administration suggest that changes in ED testing or treatment did not facilitate the decrease in admissions during periods of high hospital occupancy.

中文翻译：

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医院入住率及其对急诊科评估的影响

学习目标

检查医院入住率是否与急诊科 (ED) 评估期间增加的检测和治疗相关，从而减少入院。

方法

我们分析了一个城市学术 ED 的电子健康记录。我们将 2010 年 10 月 1 日至 2015 年 5 月 29 日期间所有 ED 就诊的数据与每日住院人数（住院患者/总人员床位）联系起来。结果测量包括实验室检测的频率、先进的影像学、药物管理和住院治疗。我们酌情使用多变量负二项式或逻辑回归对每个结果进行建模，并检查它们与每日医院入住四分位数的关联，控制患者和就诊特征。我们使用边际估计方法计算了每个每日医院入住四分位数的调整结果率和相对变化。

结果

我们纳入了 270,434 次急诊就诊，患者平均年龄为 48.1（标准差 19.8）岁；40.1% 为女性，22.8% 为非西班牙裔黑人，51.5% 为商业保险。医院入住率与实验室检测、高级成像或药物管理的差异无关。与第一个四分位数相比，每日医院入住率的第三和第四个四分位数与下降 1.5% 相关（95% 置信区间 [CI] -2.9 至 -0.2；绝对变化 -0.6 个百分点 [95% CI -1.2 至 - 0.1]）和 4.6%（95% CI -6.0 至 -3.2；绝对变化 -1.9 个百分点 [95% CI -2.5 至 -1.3]）。

结论

医院入住率与实验室检测、高级影像学和药物管理之间缺乏关联表明，ED 检测或治疗的变化并没有促进医院高入住率期间入院率的下降。