title: Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases.
abstract: BACKGROUND
  Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload.
  
  
  OBJECTIVE
  To investigate the impact of opening a new ED on patient and healthcare service outcomes.
  
  
  METHODS
  A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia.
  
  
  RESULTS
  Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED.
  
  
  CONCLUSIONS
  An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues.
authors.affiliation: Gold Coast Hospital and Health Service, Southport, Australia; Griffith Health Institute, Griffith University, Gold Coast, Australia; State Wide Emergency Department Network, Brisbane, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Crilly
authors.forename: J
authors.initials: J
authors.lastname: O'Dwyer
authors.forename: J
authors.initials: J
authors.lastname: Lind
authors.forename: V
authors.initials: V
authors.lastname: Tippett
authors.forename: L
authors.initials: L
authors.lastname: Thalib
authors.forename: M
authors.initials: M
authors.lastname: O'Dwyer
authors.forename: G
authors.initials: G
authors.lastname: Keijzers
authors.forename: M
authors.initials: M
authors.lastname: Wallis
authors.forename: N
authors.initials: N
authors.lastname: Bost
authors.forename: S
authors.initials: S
authors.lastname: Shiels
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000592:standards; D016208:Databases, Factual / Q000639:trends*; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends*; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends*; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D016526:Workload / Q000592:standards; D055815:Young Adult
keywords: crowding; data linkage; emergency health services; outcomes research