The influence of emergency department crowding on the efficiency of care for acute stroke patients.
OBJECTIVE
To investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients.


METHODS
Retrospective cohort study conducted from 1 May 2008 to 31 December 2013.


METHODS
Largest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan.


METHODS
Patients aged 18-80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142).


METHODS
Door-to-assessment time (DTA), door-to-computed tomography completion time (DTCT) and door-to-needle time (DTN).


RESULTS
Of the 785 patients with ischemic stroke, 90 (11.46%) received thrombolysis. In the multivariate regression analysis, the number of ED patients and the number of attending physicians were significantly associated with delayed DTA and DTCT but not DTN. Initial assessment by a resident was also associated with delayed DTA and DTCT. The number of nurses was associated with delayed DTCT and DTN.


CONCLUSIONS
Although ED crowding was not associated with delayed DTN, it predicted delayed DTA and DTCT in thrombolysis-eligible stroke patients. The number of attending physicians affected initial assessment and DTCTs, whereas the number of nurses impacted thrombolytic administration times.
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Ming-Ta
MT
Tsai
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Yung-Lin
YL
Yen
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Chih-Min
CM
Su
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Chih-Wei
CW
Hung
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Chia-Te
CT
Kung
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Kuan-Han
KH
Wu
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan.
Hsien-Hung
HH
Cheng
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013624:Taiwan; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D000078329:Workforce; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
acute stroke; crowding; efficiency; emergency department