Title: 331 Effect of Emergency Department Hallway Care Location on Patient Outcomes Across 14 Hospitals: Higher Rates of Return to the Emergency Department and Inpatient Admission
Abstract: Crowding in emergency departments (EDs) leads to frequent utilization of hallway beds as part of routine care. Research into the impact of care location on patient outcomes and which patients are triaged to the ED hallway is limited. The primary aim of this study was to evaluate whether hallway care location, compared to non-hallway location, was associated with 7-day and 30-day rates of return to the ED and return with inpatient admission in a network of 14 hospitals. A secondary aim was to describe the demographics and diagnoses of hallway patients compared to those in the non-hallway setting. We performed a multisite retrospective cohort study at 14 EDs comparing hallway patients to non-hallway patients. We merged administrative datasets derived from the electronic health record that included all patients evaluated from 1/1/2017 to 8/31/2018. We included patients >=18 years old who had unique identifiers and complete information on disposition. The exposure was if the patient was placed in a hallway or non-hallway bed for greater than 30 minutes during the ED encounter. We describe the relationship between patient variables, hallway exposure, and outcomes with odds ratios [95% confidence intervals]. A total of 941,253 ED encounters were identified; 797,093 nonhallway patients and 25,927 hallway patients met the inclusion criteria. Compared to patients in non-hallway locations, hallway patients had higher odds of 7-day return to the ED (1.4 [1.3, 1.5]), 7-day return with inpatient admission (1.4 [1.3, 1.5]), 30-day return to the (ED 1.2 [1.2, 1.3]), and 30-day return with inpatient admission (1.3 [1.2, 1.3]). Hallway patients had lower odds of 30-day mortality after the index visit (0.6 [0.5, 0.7]). Placement of patients in the hallway was associated with being male (OR 1.31 [1.27, 1.34]), non-white (OR 1.26 [1.23, 1.30]), having self-pay insurance (1.22 [1.16, 1.28]), and current tobacco use (1.33 [1.30, 1.36]). Hallway patients had lower odds of having a history of CAD (0.73 [0.70, 0.76]), CHF (0.78 [0.74, 0.82]), or prior stroke (0.79 [0.75, 0.84]). The top CCS diagnostic categories for the ED diagnosis in hallway patients were alcohol-related disorders (9.5%), abdominal pain (4.2%), sprains/strains (4.2%), back pain (3.8%), substance-related disorders (3.6%), superficial injury/contusion (3.6%) and non-specific chest pain (3.5%). Among hallway patients discharged from the ED who returned to the ED or required admission within 7 days, "alcohol-related disorders" was by far the most common diagnostic category (26.4%). Hallway patients have increased odds of return to the ED and inpatient admission within 7 days and 30 days of their index visit. Male, non-white patients are more likely to be placed in hallways, and the largest subset of hallway patients (13.1%) have an ED diagnosis of alcohol or substance use.
Publication Year: 2020
Publication Date: 2020-10-01
Language: en
Type: article
Indexed In: ['crossref']
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