title: Effect of emergency department crowding on pneumonia admission care components.
abstract: OBJECTIVE
  To determine pneumonia admission care components that are most affected by emergency department (ED) crowding.
  
  
  METHODS
  Secondary analysis of a cross-sectional observational survey.
  
  
  METHODS
  The setting was a 29-bed academic ED with 39,000 visits per year and state-mandated ratios of nurses to patients. The patients were ED admissions with pneumonia, January 1, 2004, to June 30, 2005. From ED medical records and databases, we abstracted the times of arrival, room placement, ordering of chest radiograph and when obtained, ordering of blood culture and when obtained, and ordering of antibiotic and when administered. We assessed associations between ED volume at the time of arrival of a patient with pneumonia and component durations using multivariate linear regression.
  
  
  RESULTS
  For 407 ED admissions with pneumonia, the median component durations (in minutes) were as follows: 20 for arrival to room placement, 44 for arrival to chest radiograph order, 10 for chest radiograph order to radiograph obtained, 120 for room placement to antibiotic order, 10 for blood culture order to culture obtained, 30 for antibiotic order to antibiotic administered, and 195 for arrival to antibiotic administered. Sixty-one percent of patients received antibiotic within 4 hours. We estimate that for every 10 additional ED patients the time from arrival to ordering of a chest radiograph was prolonged by 14.3 minutes and from ordering of antibiotic to administration by 9.3 minutes.
  
  
  CONCLUSIONS
  Despite compliance with mandated ratios of nurses to patients, the time from antibiotic ordering to administration (a nursing task) was prolonged with higher ED volumes, as were throughput measures. Targeting these may expedite treatment under crowded ED conditions.
authors: Department of Emergency Medicine, University of California, San Francisco Medical Center, 94143, USA. christopher.fee@ucsf.edu
authors: Christopher
authors: C
authors: Fee
authors: Ellen J
authors: EJ
authors: Weber
authors: Peter
authors: P
authors: Bacchetti
authors: Carley A
authors: CA
authors: Maak