PATTERNS ASSOCIATED WITH INTENSIVE UTILIZATION

Emergency department (ED) overcrowding is a problem that affects both rural and urban areas and is thought to be caused by system-wide factors, particularly the ability of hospitals to handle patient flows through the ED. Appropriate resource allocation is a priority when addressing ED overcrowding. Staffing, one of the most expensive and adjustable resources, should be allocated to reduce waiting times and control ED overcrowding by increasing staffing levels during the busiest times of the day, week, or year. Finding a way to measure ED crowding in a valid and reliable way is a first step to addressing the problem. Our research sought to better understand the patterns and factors associated with the use of ED services on high volume and intensive (high volume and severity) days to improve ED capacity and resource allocation and reduce ED overcrowding.

We created a new index of “intensive use” based on volume (in excess of average use) and severity of illness (higher levels of acuity) and a 3-part categorization (normal volume, high volume, and intensive use) to measure stress in the ED environment. We studied independent factors linked to our index and categories of ED stress. Our research identified factors associated with high volume and intensive use. Factors associated with intensive days included being in a motor vehicle crash; having a gun or stab wound; arriving during the months of January, April, May, or August; and arriving during the days of Monday, Tuesday, or Wednesday. Factors associated with high-volume days included falling from 0 to 10 ft; being in a motor vehicle crash; arriving during the months of January, April, May, or August; and arriving during the days of Monday, Tuesday, or Wednesday. These findings offer inputs for reallocating resources and altering staffing models to more efficiently provide high-quality ED services to improve health and well-being and prevent overcrowding.