Article Data

  • Views 256
  • Dowloads 153

Original Research

Open Access Special Issue

Emergency department crowdedness and emergency department cardiac arrest occurrence: an observational study in the COVID-19 pandemic

  • Yan-Bo Huang1,†
  • Su-Yu Li2,†
  • Shang-Kai Hung1
  • Li-Heng Tsai1
  • Chip-Jin Ng1
  • Shou-Yen Chen1,3

1Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, 333423 Taoyuan, Taiwan

2Department of Nursing, Chang Gung Memorial Hospital, 333423 Taoyuan, Taiwan

3Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, 333323 Taoyuan, Taiwan

DOI: 10.22514/sv.2021.236

Submitted: 05 August 2021 Accepted: 25 October 2021

Online publish date: 18 November 2021

*Corresponding Author(s): Shou-Yen Chen E-mail: allendream0621@yahoo.com.tw allendream0621@gmail.com 8902007@cgmh.org.tw

† These authors contributed equally.

Abstract

Emergency department (ED) crowdedness is a global phenomenon that can lead to many adverse effects. The relationship of crowdedness and emergency department cardiac arrest (EDCA) occurrence is still debated. The COVID-19 pandemic precipitated a change in the patient volume of the ED and the crowdedness of the ED varied with the epidemic in a continuous period. Different degrees of crowdedness provided us with an opportunity to study the relationship between crowdedness and EDCA occurrence. Our aim of this study was to determine the relationship between EDCA occurrence and prognosis and ED crowdedness.This was a longitudinal study conducted in a tertiary teaching hospital. The study period was from October 1, 2019, to September 30, 2020, and was divided into three periods according to daily patient volume and crowdedness. All nontraumatic and adult EDCA patients during the study period were included, and out-of-hospital cardiac arrest (OHCA) patients and patients with do-not-resuscitate orders were excluded.During the study period, a total of 126 EDCA patients were included. The ratio of EDCA events to daily patient volume was compared among these 3 periods, and there was no significant difference (P2: p = 0.109, P3: p = 0.761, P1 as reference). No significant difference in the prognosis of EDCA patients was found among the 3 periods, regardless of the return of spontaneous circulation (ROSC) (p = 0.437) or survival rates (p = 0.838). In conclusion, there was no obvious correlation between ED crowdedness and EDCA occurrence. The prognosis of EDCA patients was not significantly associated with crowdedness. The metrics of ED overcrowding is unknown and may need further study to develop a generally accepted standard or index.


Keywords

EDCA; Cardiac arrest; Crowdedness; Overcrowding


Cite and Share

Yan-Bo Huang,Su-Yu Li,Shang-Kai Hung,Li-Heng Tsai,Chip-Jin Ng,Shou-Yen Chen. Emergency department crowdedness and emergency department cardiac arrest occurrence: an observational study in the COVID-19 pandemic. Signa Vitae. 2021.doi:10.22514/sv.2021.236.

References

[1] Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Academic Emergency Medicine. 2011; 18: 1358–1370.

[2] Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS ONE. 2018; 13: e0203316.

[3] Bond K, Ospina MB, Blitz S, Afilalo M, Campbell SG, Bullard M, et al. Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey. Healthcare Quarterly. 2007; 10: 32–40.

[4] Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. ED overcrowding is associated with an increased frequency of medication errors. The American Journal of Emergency Medicine. 2010; 28: 304–309.

[5] Gaieski DF, Agarwal AK, Mikkelsen ME, Drumheller B, Cham Sante S, Shofer FS, et al. The impact of ED crowding on early interventions and mortality in patients with severe sepsis. The American Journal of Emergency Medicine. 2017; 35: 953–960.

[6] Jo S, Jeong T, Jin YH, Lee JB, Yoon J, Park B. ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study. The American Journal of Emergency Medicine. 2015; 33: 1725–1731.

[7] Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA: Journal of the American Medical Association. 2019; 321: 1200–1210.

[8] Donoghue AJ, Abella BS, Merchant R, Praestgaard A, Topjian A, Berg R, et al. Cardiopulmonary resuscitation for in-hospital events in the emergency department: A comparison of adult and pediatric outcomes and care processes. Resuscitation. 2015; 92: 94–100.

[9] Kayser RG, Ornato JP, Peberdy MA. Cardiac arrest in the Emergency Department: a report from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2008; 78: 151–160.

[10] Jang DH, Kim J, Jo YH, Lee JH, Hwang JE, Park SM, et al. Developing neural network models for early detection of cardiac arrest in emergency department. The American Journal of Emergency Medicine. 2020; 38: 43–49.

[11] Mitchell OJL, Edelson DP, Abella BS. Predicting cardiac arrest in the emergency department. Journal of the American College of Emergency Physicians Open. 2020; 1: 321–326.

[12] Hong S, Lee S, Lee J, Cha WC, Kim K. Prediction of Cardiac Arrest in the Emergency Department Based on Machine Learning and Sequential Characteristics: Model Development and Retrospective Clinical Validation Study. Journal of Medical Internet Research. 2020; 8: e15932.

[13] Long B, Alerhand S, Maliel K, Koyfman A. Echocardiography in cardiac arrest: an emergency medicine review. The American Journal of Emergency Medicine. 2018; 36: 488–493.

[14] Pokrajac N, Sbiroli E, Hollenbach KA, Kohn MA, Contreras E, Murray M. Risk Factors for Peri-intubation Cardiac Arrest in a Pediatric Emergency Department. Pediatric Emergency Care. 2020. (in press)

[15] Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency department crowding, part 1–concept, causes, and moral consequences. Annals of Emergency Medicine. 2009; 53: 605–611.

[16] Chang YH, Shih HM, Chen CY, Chen WK, Huang FW, Muo CH. Association of sudden in-hospital cardiac arrest with emergency department crowding. Resuscitation. 2019; 138: 106–109.

[17] Kim JS, Bae HJ, Sohn CH, Cho SE, Hwang J, Kim WY, et al. Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest. Critical Care. 2020; 24: 305.

[18] Lo HY, Chaou CH, Chang YC, Ng CJ, Chen SY. Prediction of emergency department volume and severity during a novel virus pandemic: Experience from the COVID-19 pandemic. The American Journal of Emergency Medicine. 2021; 46: 303–309.

[19] Kim JS, Seo DW, Kim YJ, Jeong J, Kang H, Han KS, et al. Prolonged Length of Stay in the Emergency Department and Increased Risk of In-Hospital Cardiac Arrest: A nationwide Population-Based Study in South Korea, 2016–2017. Journal of Clinical Medicine. 2020; 9: 2284.

[20] Ye S, Liu JZ, He YR, Cao Y. Emergency department crowding might not strongly associated with higher incidence of in-hospital cardiac arrest. Resuscitation. 2019; 140: 72–73.

[21] Hwang U, McCarthy ML, Aronsky D, Asplin B, Crane PW, Craven CK, et al. Measures of crowding in the emergency department: a systematic review. Academic Emergency Medicine. 2011; 18: 527–538.

[22] Cheng HY, Jian SW, Liu DP, Ng TC, Huang WT, Lin HH, et al. Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan and Risk at Different Exposure Periods before and after Symptom Onset. JAMA Internal Medicine. 2020; 180: 1156–1163.

[23] Steinbrook R. Contact Tracing, Testing, and Control of COVID-19-Learning From Taiwan. JAMA Internal Medicine. 2020; 180: 1163–1164.

[24] Galhotra S, DeVita MA, Simmons RL, Dew MA. Mature rapid response system and potentially avoidable cardiopulmonary arrests in hospital. Quality & Safety in Health Care. 2007; 16: 260–265.

[25] Andersen LW, Kim WY, Chase M, Berg KM, Mortensen SJ, Moskowitz A, et al. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation. 2016; 98: 112–117.

[26] Chapman SM, Maconochie IK. Early warning scores in paediatrics: an overview. Archives of Disease in Childhood. 2019; 104: 395–399.

[27] Duncan H, Hutchison J, Parshuram CS. The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children. Journal of Critical Care. 2006; 21: 271–278.

[28] Smith ME, Chiovaro JC, O’Neil M, Kansagara D, Quiñones AR, Freeman M, et al. Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. Annals of the American Thoracic Society. 2014; 11: 1454–1465.

[29] Chan PS, Spertus JA, Krumholz HM, Berg RA, Li Y, Sasson C, et al. A validated prediction tool for initial survivors of in-hospital cardiac arrest. Archives of Internal Medicine. 2012; 172: 947–953.

[30] Harrison DA, Patel K, Nixon E, Soar J, Smith GB, Gwinnutt C, et al. Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team. Resuscitation. 2014; 85: 993–1000.

[31] Bircher NG, Chan PS, Xu Y. Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest. Anesthesiology. 2019; 130: 414–422.

[32] Wallace SK, Abella BS, Becker LB. Quantifying the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome: a systematic review and meta-analysis. Circulation. Cardiovascular quality and outcomes. 2013; 6: 148–156.

[33] Kang J, Kim J, Jo YH, Kim K, Lee JH, Kim T, et al. ED crowding and the outcomes of out-of-hospital cardiac arrest. The American Journal of Emergency Medicine. 2015; 33: 1659–1664.

[34] Montrief T, Ramzy M, Long B, Gottlieb M, Hercz D. COVID-19 respiratory support in the emergency department setting. The American Journal of Emergency Medicine. 2020; 38: 2160–2168.

[35] Chavez S, Long B, Koyfman A, Liang SY. Coronavirus Disease (COVID-19): A primer for emergency physicians. The American Journal of Emergency Medicine. 2021; 44: 220–229.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top