Evidence map›Paper›PMID 26003004›Full record

ArticleAnnals of emergency medicine2015

Emergency Department Crowding and Outcomes After Emergency Department Discharge.

Gelareh Z Gabayan, Stephen F Derose, Vicki Y Chiu, Sau C Yiu, Catherine A Sarkisian, Jason P Jones, Benjamin C Sun

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
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  4. Article
  5. Article
  6. Review
  7. Article
  8. Observational
  9. Article
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  11. Article
  12. Outcomes of Crowding in Emergency Departments; a Systematic Review.Archives of academic emergency medicine · 2019
    Review
  13. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Gelareh Z GabayanDepartment of Medicine, University of California, and the Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA. Electronic address: gelareh@gabayan.com.
Stephen F DeroseKasier Permanente Southern California, Department of Research and Evaluation, Pasadena, CA.
Vicki Y ChiuKasier Permanente Southern California, Department of Research and Evaluation, Pasadena, CA.
Sau C YiuKasier Permanente Southern California, Department of Research and Evaluation, Pasadena, CA.
Catherine A SarkisianDepartment of Medicine, University of California, and the Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA.
Jason P JonesKasier Permanente Southern California, Department of Research and Evaluation, Pasadena, CA.
Benjamin C SunDepartment of Emergency Medicine, Oregon Health and Science University, Portland, OR.

Funding

UCLA Clinical and Translational Science InstituteKL2TR000122 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2012 to 2015
$4.5M
Effects of Emergency Department Crowding on Patient SafetyR03HS018994 · AHRQ · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI GABAYAN, GELAREH Z. · 2010 to 2010
$100k
AHRQ HHS R03 HS018994AHRQ HHS R03 HS18994NCATS NIH HHS KL2 TR000122NCATS NIH HHS KL2TR000122
6 · The paper itself

Abstract

STUDY

objectiveWe assess whether a panel of emergency department (ED) crowding measures, including 2 reported by the Centers for Medicare & Medicaid Services (CMS), is associated with inpatient admission and death within 7 days of ED discharge.

methodsWe conducted a retrospective cohort study of ED discharges, using data from an integrated health system for 2008 to 2010. We assessed patient transit-level (n=3) and ED system-level (n=6) measures of crowding, using multivariable logistic regression models. The outcome measures were inpatient admission or death within 7 days of ED discharge. We defined a clinically important association by assessing the relative risk ratio and 95% confidence interval (CI) difference and also compared risks at the 99th percentile and median value of each measure.

resultsThe study cohort contained a total of 625,096 visits to 12 EDs. There were 16,957 (2.7%) admissions and 328 (0.05%) deaths within 7 days. Only 2 measures, both of which were patient transit measures, were associated with the outcome. Compared with a median evaluation time of 2.2 hours, the evaluation time of 10.8 hours (99th percentile) was associated with a relative risk of 3.9 (95% CI 3.7 to 4.1) of an admission. Compared with a median ED length of stay (a CMS measure) of 2.8 hours, the 99th percentile ED length of stay of 11.6 hours was associated with a relative risk of 3.5 (95% CI 3.3 to 3.7) of admission. No system measure of ED crowding was associated with outcomes.

conclusionOur findings suggest that ED length of stay is a proxy for unmeasured differences in case mix and challenge the validity of the CMS metric as a safety measure for discharged patients.

Indexed as

CrowdingPatient DischargeCaliforniaEmergency Service, HospitalFemaleHumansLength of StayMaleRetrospective StudiesWaiting Lists

Identifiers

PMID26003004
PMCPMC5270644

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.