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The impact of opening a new emergency department on health care service and patient outcomes: Analyses based on linking Ambulance, Emergency and Hospital databases
Journal article   Peer reviewed

The impact of opening a new emergency department on health care service and patient outcomes: Analyses based on linking Ambulance, Emergency and Hospital databases

J Crilly, J O'Dwyer, J Lind, V Tippett, Lukman Thalib, M O'Dwyer, G Keijzers, Marianne Wallis, N Bost and S Shiels
Internal Medicine Journal, Vol.43(12), pp.1293-1303
2013
DOI: https://doi.org/10.1111/imj.12202
url
https://doi.org/10.1111/imj.12202View
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Abstract

emergency health services data linkage outcomes research crowding
Background: Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired health care delivery, negative patient outcomes and increased staff workload. Aim To investigate the impact of opening a new ED on patient and healthcare service outcomes. Method A 24 month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. Results Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10mins, POST: 10mins, p less than 0.001; Hospital B PRE: 10mins, POST: 15mins, p less than 0.001); ED LOS: (Hospital A PRE: 242mins, POST: 246mins, p less than 0.001; Hospital B PRE: 182mins, POST: 210mins, p less than 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, p less than 0.001; Hospital B PRE: 23%, POST: 40%, p less than 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. Conclusions An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues

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