Higher 10-day mortality of lower-acuity patients during times of increased ED crowding
Background: Studies have assessed mortality effect from ED crowding on high-acuity patients, but limited evidence exists for how this affects lower-acuity patients who are discharged home.
Dr. Adam Merando
Study design: Retrospective cohort study.
Setting: Emergency department, Karolinska University Hospital, Solna, Sweden.
Synopsis: During 2009-2016, 705,813 encounters seen in the ED, triaged to lower-acuity levels 3-5 and discharged without further hospitalization needs were identified. A total of 623 patients died within 10 days of the initial ED visit (0.09%). The study evaluated the association of 10-day mortality with mean ED length of stay and ED-occupancy ratio.
The study demonstrated an increased 10-day mortality for mean ED length of stay of 8 hours or more vs. less than 2 hours (adjusted odds ratio, 5.86; 95% CI, 2.15-15.94). It also found an increased mortality rate for occupancy ratio quartiles with an aOR for quartiles 2, 3, and 4 vs. quartile 1 of 1.48 (95% CI, 1.14-1.92), 1.63 (95% CI, 1.24-2.14), and 1.53 (95% CI, 1.15-2.03), respectively.
While this suggests increased 10-day mortality in this patient population, additional studies should be conducted to determine if this risk is caused by ED crowding and length of stay or by current limitations in triage scoring.
Bottom line: There is an increased 10-day mortality rate for lower-acuity triaged patients who were discharged from the ED without hospitalization experiencing increased ED length of stay and during times of ED crowding.
Citation: Berg L et al. Associations between crowding and 10-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department. Ann Emerg Med. 2019 Sep;74(3):345-56.
Dr. Merando is a hospitalist and assistant professor of internal medicine at St. Louis University School of Medicine.
