title: Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmissions?
abstract: OBJECTIVE
  We evaluate the effect of a multifaceted intervention to decrease emergency department crowding on the incidence of return visits to the ED or a hospital ward. The intervention included increased emergency physician coverage, the designation of physician coordinators, and new hospital policies regarding laboratory, consultation, and admission procedures.
  
  
  METHODS
  The incidence of return visits within 7 days of discharge was estimated in samples from 2 populations (ie, patients discharged from the ED and patients discharged from the hospital) and during a 12-month period before and a 12-month period after the implementation of the intervention. Return visits were categorized into the following groups: (1) scheduled or not and (2) related or not to initial visit. Logistic regression was used in subsamples to assess the effect of the intervention while controlling for potential confounders. By using information from the provincial medical services database, variation between the periods before and after implementation of the intervention in the incidence of return visits to any ED was compared between the study hospital and 2 external control hospitals.
  
  
  RESULTS
  No difference was found in the incidence of return visits between the periods before and after implementation of the intervention, either for patients discharged from the ED (all returns: 11.0% versus 12.4%, 95% confidence interval on difference [CID] -1.5% to 4.3%; unscheduled-related returns: 6.5% versus 5.8%, 95% CID -2.8% to 1.6%) or the hospital (all returns: 6.8% versus 6.6%, 95% CID -2.5% to 2.1%; unscheduled-related returns: 4.2% versus 4.0%, 95% CID -2.0% to 1.7%). This lack of effect remained even after controlling for potential confounders. Variation between the periods before and after implementation of the intervention in the incidence of return to any ED was similar in the 3 hospitals examined.
  
  
  CONCLUSIONS
  Our successful hospital intervention to decrease crowding reduced the mean length of stay for patients discharged from the ED from 13.8 to 5.9 hours, without resulting in increased return visits to the ED or hospital readmission.
authors.affiliation: Emergency Department, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cardin
authors.forename: Marc
authors.initials: M
authors.lastname: Afilalo
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Collet
authors.forename: Antoinette
authors.initials: A
authors.lastname: Colacone
authors.forename: Chris
authors.initials: C
authors.lastname: Tselios
authors.forename: Jerry
authors.initials: J
authors.lastname: Dankoff
authors.forename: Alex
authors.initials: A
authors.lastname: Guttman
mesh_terms: D000368:Aged; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011792:Quebec; D000078329:Workforce