title: [Failure of a special winter programme aimed to alleviate negative effects of winter overload on an emergency department].
abstract: OBJECTIVE
  We aimed: a) to determine changes in patient flow, and in emergency department (ED) effectiveness and quality that may happen depending on the season (winter/non-winter), and b) to analyze effects on those changes when a special winter programme (SWP) of the Pla Integral d'Urgències de Catalunya (PIUC) is applied.
  
  
  METHODS
  We studied 4 weeks of each period: non-winter period, winter control period (without SWP), winter period with SWP. Within the 3 periods, the daily census was taken as a proxy of external pressure, and the number of patients admitted to the hospital from the ED as a proxy of internal pressure. In each period, effectiveness markers--ED occupancy rate, rate of ED patients waiting for a bed, waiting time (WT) and number of patients waiting to be seen (PW), length of stay-- objective quality markers -revisit rate, rate of patients left without being seen, rate of patients left against medical advise (LAMA), and mortality rate-, and subjective quality markers -patient satisfaction with the physician, the nurse, the general ED organization, and level of complaint solution- were recorded.
  
  
  RESULTS
  Compared to the non-winter period, in the winter period without SWP the daily census rose by 6% (p = 0.07), and the number of patients admitted 10.8% (p = 0.16). These increases went along with a worsening of almost all effectiveness and quality markers, although only PW (+63%; p < 0.01), WT (+130%; p < 0.001), length of stay (+28%; p < 0.05), rate of patients left without being seen (+97%; p < 0.001) and LAMA (+218%; p < 0.05) reached statistical significance. In the winter period with SWP, the daily census kept stable but the number of patients admitted grew by 18% (p < 0.01). The SWP improved some subjective quality markers (patient satisfaction with the physician and the nurse), but failed to improve any effectiveness or objective quality marker. Some of them got even worse within the SWP period: ED occupancy rate, +20% (p = 0.001); PW, +42% (p < 0.05), and WT, +56% (p < 0.05).
  
  
  CONCLUSIONS
  In winter, a worsening of ED effectiveness and quality can be expected. Measures from the SWP prepared by the Administration are unable to correct such deterioration. A profound analysis of the SWP is suggested.
authors: Sección de Urgencias de Medicina, Area de Urgencias, Hospital Clínic, Barcelona, España.
authors: Emilio
authors: E
authors: Salgado
authors: Albert
authors: A
authors: Antolín
authors: Dolores
authors: D
authors: Rodríguez
authors: Ernest
authors: E
authors: Bragulat
authors: Miquel
authors: M
authors: Sánchez
authors: Oscar
authors: O
authors: Miró
mesh_terms: D001509:Bed Occupancy; D003627:Data Interpretation, Statistical; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D006291:Health Policy; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012621:Seasons; D013030:Spain; D013997:Time Factors