title: Expanding emergency department capacity: a multisite study.
abstract: OBJECTIVE
  The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area.
  
  
  METHODS
  The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission.
  
  
  RESULTS
  Almost one-third of all 286037 ED presentations were via ambulance (n=79196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS >4h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4h, and decreased for ATS category and ED diagnoses.
  
  
  CONCLUSIONS
  Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered.
authors.affiliation: Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: ; ;
authors.forename: Julia L
authors.initials: JL
authors.lastname: Crilly
authors.affiliation: Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: ; ;
authors.forename: Gerben B
authors.initials: GB
authors.lastname: Keijzers
authors.affiliation: Faculty of Health, School of Clinical Sciences, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia. Email:
authors.forename: Vivienne C
authors.initials: VC
authors.lastname: Tippett
authors.affiliation: Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: ; ;
authors.forename: John A
authors.initials: JA
authors.lastname: O'Dwyer
authors.affiliation: Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: ; ;
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Wallis
authors.affiliation: Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: ; ;
authors.forename: James F
authors.initials: JF
authors.lastname: Lind
authors.affiliation: Emergency Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: ; ;
authors.forename: Nerolie F
authors.initials: NF
authors.lastname: Bost
authors.affiliation: Australian eHealth Research Centre, Level 5, UQ Health Sciences Building 901/16, Royal Brisbane & Women's Hospital, Herston, Qld 4029, Australia. Email: ;
authors.forename: Marilla A
authors.initials: MA
authors.lastname: O'Dwyer
authors.affiliation: Logan Hospital, Queensland Health, Corner Armstrong and Loganlea Roads, Meadowbrook, Qld 4131, Australia. Email:
authors.forename: Sue
authors.initials: S
authors.lastname: Shiels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057191:Capacity Building / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult