Bed Utilization and Overcrowding in a High-Volume Tertiary Level Pediatric Emergency Department

摘要

Objectives To measure bed utilization rate and overcrowding in a high-volume tertiary level pediatric emergency department (ED) and correlate with outcome. Methods All children beyond neonatal age attending the 22-bedded emergency were prospectively enrolled from February to December, 2019. Number of daily admissions, boarders, discharges, ward transfers, length of stay (LOS) and unfavorable outcomes (care discontinuation and deaths) were recorded. Daily bed occupancy rate (BOR) was calculated and correlated with unfavorable outcome. Results A total of 17,463 children visited the ED during the study period. The median (IQR) daily attendance and admission rate was 58 (51,65) and 22 (17,26) patients, respectively. The median (IQR) number of boarders and BOR was 48 (40–58) and 218% (181–263%), respectively. The median (IQR) LOS was 42.7 (23–71.4) hours. Unfavorable outcome correlated positively with number of boarders and BOR ( P <0.001). Conclusions Overcrowding of the ED was associated with increased frequency of care discontinuation and mortality. This data calls for systemic changes to tackle overcrowding.