title: 'Care in a chair' - The impact of an overcrowded Emergency Department on the time to treatment and length of stay of self-presenting patients with abdominal pain.
abstract: OBJECTIVE
  The aim in this study was to investigate the impact of overcrowding on the Australasian Triage Score's (ATS) time to treatment target and the National Emergency Access Target (NEAT) for patients who self-present to the Emergency Department (ED) with abdominal pain.
  
  
  BACKGROUND
  The causes and effects of ED overcrowding have been well described in the literature. It is a widespread phenomenon throughout the world and it can cause serious harm to patients and have a negative impact on access to emergency care. There is however, little research investigating the effect of overcrowding when patients self-present to the ED and experience a delay in being allocated a cubicle.
  
  
  METHODS
  A retrospective analysis of 12-months of computerised records was carried out in order to determine if self-presenting patients with abdominal pain allocated a category 3 triage score who were required to 'queue' for a cubicle would meet ATS target and NEAT requirements. A multiple regression analysis was used to determine whether or not queuing for an ED cubicle, age and gender were predictors of meeting the ATS guidelines and NEAT requirements.
  
  
  RESULTS
  Three hundred and five patients met the inclusion criteria and were included in the study. Of these 149 patients waited more than 15min to be allocated a cubicle while 156 did not experience any delay. A multiple regression analysis revealed that gender and age were not predictive of meeting the ATS target and NEAT requirements, while delay in allocation to a cubicle was a significant predictor of not being assessed within 30min and discharged within 4h. Furthermore, 61.2% of patients allocated to the waiting room queue for any amount of time were admitted to the ward.
  
  
  CONCLUSIONS
  Queuing in the waiting room for an ED bed was a significant predictor of whether or not category three patients with abdominal pain had treatment commenced within 30min of presentation and was associated with a longer total ED length of stay.
authors.affiliation: School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Smith
authors.affiliation: School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia. Electronic address: s.bouchoucha@deakin.edu.au.
authors.forename: Stephane
authors.initials: S
authors.lastname: Bouchoucha
authors.affiliation: School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Watt
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000328:Adult; D000368:Aged; D001315:Australia; D003441:Crowding; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage / Q000145:classification / Q000706:statistics & numerical data
keywords: Abdominal pain; Ambulance; Emergency Department; Overcrowding; Ramping; Self-presenters