: Emergency department (ED) crowding has strained the acute care system to its breaking point. Two of the most visible symptoms of ED crowding, ambulance diversion and 'left before being seen'visit rates, have dramatically increased over time and are now routine in many urban centers. ED crowding causes delays in evaluation and treatment, which in turn may contribute to adverse outcomes. Consequently, the American College of Emergency Physicians has identified ED crowding as one of the top problems threatening the safety and quality of emergency care. However, policymakers and health system leaders have failed to address emergency department crowding as a top public health priority. The primary reason for inaction is the paucity of data on community disparities in ED crowding and the impact of ED crowding on patient outcomes. Without such evidence, policymakers are unlikely to commit substantial resources to address root causes of ED crowding. In order to assess patterns and outcomes of ED crowding, we propose a retrospective cohort study of all 2007 ED visits to non-federal, California hospitals. This analysis will include 8.8 million discharges and 1.5 million hospitalizations from 342 California EDs. We will use daily ambulance diversion hours and 'left before being seen'(LBBS) visit rates as measures of ED crowding. This study has the following Specific Aims: 1. Identify community level predictors of emergency department crowding. 2. Assess the relationship between emergency department crowding and 7-day bounce-back hospitalizations after emergency department discharge. 3. Assess the relationship between emergency department crowding and inpatient outcomes, including death, length-of-stay, and costs. California accounts for nearly 10% of all ED visits in the United States and represents a diversity of patient populations and hospital systems. Therefore, the proposed study will provide generalizable insights into this health policy crisis.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Small Research Grants (R03)
Project #
5R03HS018098-02
Application #
7858223
Study Section
Health Systems Research (HSR)
Program Officer
Hagan, Michael
Project Start
2009-07-01
Project End
2011-06-30
Budget Start
2010-07-01
Budget End
2011-06-30
Support Year
2
Fiscal Year
2010
Total Cost
Indirect Cost
Name
University of California Los Angeles
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Gabayan, Gelareh Z; Sarkisian, Catherine A; Liang, Li-Jung et al. (2015) Predictors of admission after emergency department discharge in older adults. J Am Geriatr Soc 63:39-45
Gabayan, Gelareh Z; Asch, Steven M; Hsia, Renee Y et al. (2013) Factors associated with short-term bounce-back admissions after emergency department discharge. Ann Emerg Med 62:136-144.e1
Sun, Benjamin C; Hsia, Renee Y; Weiss, Robert E et al. (2013) Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med 61:605-611.e6
Reuben, David B; Magasi, Susan; McCreath, Heather E et al. (2013) Motor assessment using the NIH Toolbox. Neurology 80:S65-75
Hsia, Renee Y; Asch, Steven M; Weiss, Robert E et al. (2013) Is emergency department crowding associated with increased ""bounceback"" admissions? Med Care 51:1008-14
Hsia, Renee Yuen-Jan; Asch, Steven M; Weiss, Robert E et al. (2012) California hospitals serving large minority populations were more likely than others to employ ambulance diversion. Health Aff (Millwood) 31:1767-76
Hsia, Renee Y; Asch, Steven M; Weiss, Robert E et al. (2011) Hospital determinants of emergency department left without being seen rates. Ann Emerg Med 58:24-32.e3