title: Patients presenting at the emergency department with acute abdominal pain are less likely to be admitted to inpatient wards at times of access block: a registry study.
abstract: BACKGROUND
  Also known as access block, shortage of inpatient beds is a common cause of emergency department (ED) boarding and overcrowding, which are both associated with impaired quality of care. Recent studies have suggested that access block not simply causes boarding in EDs, but may also result in that patients are less likely to be admitted to the hospital from the ED. The present study's aim was to investigate whether this effect remained for patients with acute abdominal pain, for which different management strategies have emerged. Access block was defined in terms of hospital occupancy and the appropriateness of ED discharges addressed as 72 h revisits to the ED.
  
  
  METHODS
  As a registry study of ED administrative data, the study examined a population of patients who presented with acute abdominal pain at the ED of a 420-bed hospital in southern Sweden during 2011-2013. Associations between exposure and outcomes were addressed in contingency tables and by logistic regression models.
  
  
  RESULTS
  Crude analysis revealed a negative association between access block and the probability of inpatient admission (38.6 % admitted at 0-95 % occupancy, 37.8 % at 95-100 % occupancy, and 35.0 % at ≥ 100 % occupancy) (p < .001). No significant associations between exposure and 72 h revisits emerged. Multivariable models indicated an odds ratio of inpatient admission of 0.992 (95 % CI: 0.986-0.997) per percentage increase in hospital occupancy.
  
  
  CONCLUSIONS
  Study findings indicate that patients with acute abdominal pain are less likely to be admitted to the hospital from the ED at times of access block and that other management strategies are employed instead. No association with 72 h revisits was seen, but future studies need to address more granular outcomes in order to clarify the safety aspects of the effect.
authors.affiliation: Department of Clinical Sciences Lund, Lund University, HS 32, EA-blocket, 2nd floor, SE-22185, Lund, Sweden. mathias.blom@med.lu.se.
authors.forename: M C
authors.initials: MC
authors.lastname: Blom
authors.affiliation: Department of Clinical Sciences Lund, Lund University, HS 32, EA-blocket, 2nd floor, SE-22185, Lund, Sweden. mona.landin-olsson@med.lu.se.
authors.forename: M
authors.initials: M
authors.lastname: Landin-Olsson
authors.affiliation: Department of Surgery, Ystad General Hospital, Kristianstadsvägen 3A, SE-27182, Ystad, Sweden. martin.lindsten@mail.com.
authors.forename: M
authors.initials: M
authors.lastname: Lindsten
authors.affiliation: Department of Pre- and Intrahospital Emergency Medicine, Helsingborg General Hospital, S Vallgatan 5, SE-25187, Helsingborg, Sweden. Fredrik.N.Jonsson@skane.se.
authors.forename: F
authors.initials: F
authors.lastname: Jonsson
authors.affiliation: Department of Clinical Sciences Lund, Lund University, HS 32, EA-blocket, 2nd floor, SE-22185, Lund, Sweden. kjell.ivarsson@med.lu.se.
authors.forename: K
authors.initials: K
authors.lastname: Ivarsson
mesh_terms: D000006:Abdomen, Acute / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors; D013548:Sweden; D014218:Triage; D014850:Waiting Lists