[The collapse of the hospital emergency services during the winter]

Variability and Overcrowding Management

Emergency department (ED) overcrowding has become a common situation with significant negative effects on the quality of care. The aim of this study is to detail the flow of patients and their variability and determine the existence of stable patterns that allow better planning of resources.

We performed a retrospective descriptive observational study of emergencies attended from 2008 to 2010 in the ‘Juan Ramón Jiménez’ General Hospital (Huelva, Spain), with a sample of 343,233 visits. The time between consecutive arrivals of patients and the arrival patterns according to severity and clinical area was calculated using Microsoft Excel and Stat::Fit. Quarterly differences were determined using the Kruskal–Wallis test.

The mean value of the inter-arrival time, independent of the quarter ( p < 0.05), was 2–4 minutes from 10:00 am to 10:00 pm and 15–20 minutes from midnight to 8:00 am. The Priority (P) I Patients arrived every 119.05 ± 136.71 minutes, the PII patients every 75.96 ± 97.58 minutes, the PIII patients every 22.62 ± 33.47 minutes and the PIV patients every 6.37 ± 10.53 minutes. PIV had a fluctuating pattern. The arrival rate peaks at 1:00 pm on Monday in the medical–surgical area, at 10:00 pm on Monday for the trauma area, and at 1:00 pm on Sunday for the paediatric area.

The study shows that inter-arrival times and average arrival rates of patients have a defined and reproducible pattern for each level of severity and clinical area, which forces us to rethink the fixed capacity model and oriented towards flexibility of resources to reduce the overcrowding.

[Variability in Spanish National Health System hospital emergency services utilization]

OBJECTIVE

The aims of this study were to estimate the rate of hospital emergency services (HES) visits per health area, the associated percentage of admissions and the standardized HES utilization ratio, and to analyze their relationship with hospital resources.

METHODS

We performed an ecological study that combined information from distinct sources (Survey of Health Care Hospitalization Establishments 2006 and Minimum Data Set 2006) to estimate the rate of HES visits and the percentage of associated emergency admissions in 164 health areas in 14 autonomous communities (AC).

RESULTS

Among 35.3 million inhabitants in the 164 areas examined, there were 16.2 million visits to the HES (45.75 per 100 inhabitants); more than 2 million (12.6%) were hospitalized. Excluding 5% of extreme areas, rates oscillated between 31.60 and 78.69 HES visits/100 inhabitants, and the percentage of admissions was between 7.6% and 27.9%. These differences were not attenuated after standardization. The AC factor explained 29% of variance in HES visits and 82% of variance in admissions. The rate of visits was not associated with the number of beds or staff physicians but did correlate with the number HES doctors, and smaller and non-teaching hospitals.

CONCLUSIONS

There is wide variability in the rates of HES visits and emergency admissions in the different areas of the Spanish National Health System. This variability seems to be associated with a differential use for minor problems.

[Not Available]

OBJECTIVE

To determine the effectiveness of a model centred in the admission unit that prioritises the daily assignment of available hospital beds.

MATERIAL AND METHODS

This model started on June 1st 2005 with the implementation of a series of interventions: 1) Definition of the proceedings of the admission unit; 2) A daily planning decision-making meeting; 3) Opening of a 24-hour emergency department holding unit; 4) Priority bed assignment system; and 5) Appropriateness of emergency medical and elective surgical admissions. We used 8 parameters obtained from the hospital automated database. The data have been analysed in three different annual periods: 2004 (before intervention), 2005 (intervention) and 2006 (after ntervention).

RESULTS

Number of emergencies seen: 2004 (124,301), 2005 (123,390),2006 (129,389); number emergency admissions: 2004 (13,629), 2005 (14,649), 2006 (11,690); number of elective admissions: 2004 (12,320), 2005 (12,791), 2006 (13,615); ED admission rate: 2004 (11.0 %), 2005 (11.9 %), 2006 (9.2 %), P=.004; emergency pressure: 2004 (52.5 %), 2005 (53.4 %), 2006 (46.2 %), P=.002; ED mean length of stay per patient: 2004 (9h 45m), 2005 (6h 46m), 2006 (5h 39m); number of emergency admissions waiting for a hospital bed at 8 a.m: 2004 (5341), 2005 (4484), 2006 (2787); elective surgical interventions cancellation rate: 2004 (3.4 %), 2005 (3.7 %), 2006 (2.6 %), P=.002.

CONCLUSIONS

Centralized assignment of hospital beds by the admission unit has proved to be an effective tool for hospital management.

Urgencias hospitalarias y de atención primaria en Asturias: variaciones entre áreas sanitarias y evolución desde 1994 hasta 2001

OBJECTIVE

To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability.

METHODS

Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics.

RESULTS

Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period.

CONCLUSIONS

Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts.