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Patients may be harmed in hospitals with overcrowded emergency rooms

by Pragati Singh

Prior research has shown that patients treated in a packed emergency department get sicker and are more likely to die than those treated in less crowded circumstances; nevertheless, the issues associated with emergency department crowding do not end at the unit’s door.
According to new Penn State research, overcrowded emergency rooms are connected with increased rates of death across the hospital. In a new study published at the journal Health Services Research, researchers from Penn State and the University of California, San Francisco discovered that patients in a hospital’s emergency department are 5.4% more likely to die from any cause on days when the emergency room is overcrowded.

Between October 2015 and the end of 2017, the researchers evaluated over five million discharge records from hospitals throughout California. Except for data from the smaller hospitals, patients under the age of 20, and patients moved between hospitals, all hospital discharges in the state were recorded. The researchers discovered that persons were more likely to die on days when their hospital’s emergency room was overcrowded.
The researchers quantified congestion in the study by measuring the number of individuals in the emergency department. In theory, emergency department congestion is more complicated than the number of individuals in the department; it also includes the degree of personnel, the number of available inpatient beds, and the complexity of the cases being handled.

Nonetheless, past research has demonstrated that the number of persons in the emergency department may serve as an accurate proxy for all of these variables.
“While it is well understood that a lack of available inpatient beds can lead to emergency department crowding, this is the first study to look at whether this crowding is associated with problems throughout the hospital,” said Charleen Hsuan, assistant professor of health policy and administration and lead author of the study. “Because this link was identified recently, we do not know for certain what causes the rise in mortality, but increased workload for inpatient nurses and doctors appears to be one plausible contributor.”
Throughout the trial, an average of 2.6% of hospital patients died during inpatient stays. People at a hospital’s emergency department were more likely to die as the emergency room got more congested. When emergency room occupancy was higher than typical, inpatients were 3.1% more likely to die. When emergency rooms became overcrowded, inpatients were 3.8% more likely to die than the overall death rate. Patients were 5.4% more likely to die when emergency departments were the busiest.
“We are not claiming that individuals are dying as a result of emergency department overcrowding,” Hsuan clarified. “The causes of death have not been investigated.” These findings, however, demonstrate that when emergency rooms were overcrowded, hundreds more individuals died each year than when they were less packed.

Whatever the explanation or reasons, that phenomena must be understood.”
The researchers believe that the problem must be addressed, but that it is too early to put remedies in place. One aspect is that the data were gathered in California, one of the few states in the US that mandates minimum nurse staffing levels. It is probable, though this has not been tested, that the fatality rate is higher when an emergency room is overcrowded in states with lower nurse staffing levels. More study is required to comprehend the scale of the problem as well as the ramifications of these results.
“One thing is certain: emergency department congestion is a hospital-wide issue,” Hsuan added. “When legislators and hospital executives evaluate this issue, they must consider the implications for all patients, not just those in the emergency department. Policymakers may need to take a systems-level approach to enhancing hospital care quality.”



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