How Does Emergency Room Crowding Affect Care of Septic Patients?

MedicalResearch.com Interview with:

Anish Agarwal, MD, MPH The Hospital of the University of Pennsylvania Department of Emergency Medicine Philadelphia, PA

Dr. Anish Agarwal

Anish Agarwal, MD, MPH
The Hospital of the University of Pennsylvania
Department of Emergency Medicine
Philadelphia, PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The morbidity and mortality of severe sepsis has been well studied and documented. An aggressive approach to protocolized care for patients suffering from severe sepsis and septic shock has been shown to improve mortality and should be started as early in the time course of a patient’s presentation. Emergency departments (ED) are designed to deliver time-sensitive therapies, however, they also may suffer from crowding due to multiple factors.

This study aimed to assess the impact of ED crowding upon critical interventions in the treatment of severe sepsis including time to intravenous fluids, antibiotics, and overall delivery of a protocolized bundle of care. The study found that as ED crowding increased, time to critical therapies significantly increased and the overall implementation of procotolized care decreased. More specifically as ED occupancy and total patient hours within the ED increased, time to intravenous fluids decreased and time to antibiotics increased as occupancy, hours, and boarding increased.

MedicalResearch.com: What should readers take away from your report?

Response: ED crowding has been shown to impact many disease states and this is the first North American study to reveal the impact of crowding upon critical interventions in the treatment of severe sepsis and septic shock. This study reveals some of the intricate correlations between ED crowding metrics and ED based treatments.

Of note, in our single centered study, mortality was not significantly different. Interestingly, the only ED crowding metric to impact the utilization of protocolized care in our multivariate analysis was number of boarding inpatients. The implications of boarding patients clearly are multi-faceted and place strains on many aspects of clinical care within EDs and this may need to be considered as CMS begins to release and track core measures for US health systems.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our study begins to expose some of implications of crowding on the care of critically ill patient in the Emergency Department. It would be interesting to complete a multi-center study to understand a more comprehensive investigation across different health systems. In addition, further studies aimed at improving any of the ED crowding metrics and the subsequent impact upon the care delivered to the patient would be an great next step.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

The impact of emergency department crowding on early interventions and mortality in patients with severe sepsis

David F. Gaieski, MD, Anish K. Agarwal, MD, MPH
January 30, 2017
American Journal Emergency Medicine

DOI: http://dx.doi.org/10.1016/j.ajem.2017.01.061

http://www.ajemjournal.com/article/S0735-6757(17)30081-5/references

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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