Thursday, March 24, 2016

Less crowded EDs = less waiting & "big data" isn't so big

Two recent papers caught my eye. As usual, I will preface my critiques with a disclaimer that I have never written a Nobel Prize-winning paper myself.

The first paper, “Emergency department ‘undercrowding’ is associated with decreased waiting times” appeared online in the journal Emergency Medicine Australasia.

The authors looked at emergency department patient numbers and waiting times before and after a nearby tertiary care hospital opened a new emergency department.

Their main finding was that after the new ED opened, their ED saw 28% fewer patients with a concomitant decrease in patient waiting times of 15 minutes from 26 to 11 minutes with p < 0.001, a significant difference.

They concluded, “Wait times are strongly associated with patient presentation numbers.” Furthermore, “Controlling demand may benefit patient processing, flow, and patient perceptions of level of care.”

Finally we have proof that having fewer patients in an ED results in shorter waiting times.

Other than having another entity open a new ED in your hospital’s area, they do not suggest how patient demand can be controlled especially if people use EDs for broken nails, hiccups, and insomnia.

The second paper, “Outcomes and resource use of sepsis-associated stays by presence on admission, severity, and hospital type,” is in the March 2016 issue of the open access journal Medical Care.

Using administrative data, the study compared sepsis outcomes in five community hospitals to one academic medical center and found the mortality rates for sepsis were 15.1% and 22.5% (p < 0.001), respectively.

The study involved 5672 patients—1584 admitted to a 799-bed academic medical center and 4088 admitted to community hospitals.

The characteristics of the patients in the two groups differed significantly in just about every parameter you can think of including presentation stage of sepsis, worst stage of sepsis attained during stay, length of stay, costs, and DRG complexities. There was no attempt to control for any of these variables. It's not surprising that the sicker patients in the academic medical center fared worse.

The website featured a story about this paper headlined “Big data analytics show more sepsis deaths in large hospitals.”

How big does data have to be before it's considered "big data"? Is it more than data on 5672 patients?

What about large hospitals? Can you say that a paper about one large hospital means that all large hospitals would have more sepsis deaths?


artiger said...

Undercrowding the ED may work Down Under, but it probably wouldn't work in the dysfunctional US system.

Anonymous said...

What caught my eye in the first paper is that the "denominator", viz., resources available at the ERs, isn't discussed at all.

Other bottlenecks may arise (or, in the case of the aussie paper, disappear) depending on how resources are organized. An interesting result related to this is Little's Law —

Maybe the large drop in waiting times after a relatively small reduction in demand occurred because some organizational inefficiency became less burdensome with a lower caseload.

Skeptical Scalpel said...

Ad tiger, I think that any ED in the US would be less busy if a nearby hospital opened a new ED.

Little's Law--very interesting. Good point about the resources too. If the staffing numbers stayed the same with fewer patients arriving, those patients could be seen sooner.

artiger said...

Scalpel, there was sarcasm in my post that may have been missed.

Anonymous said...

Anonymous Europe: Greetings from Spain!:) I am on my holiday here.:) What is new in the paper with the ED?? I thought it is logical that if another hospital opens an ED near another, then the patientload will be divided between the two....Why is this new information?

Skeptical Scalpel said...

Sarcasm is hard to express on the Internet.

It's not new information. It's something that really didn't require a study.

Anonymous said...

Further proof that academic types will publish any obvious things to get their names on another journal article and, they hope, thereby advance their careers

Skeptical Scalpel said...

So it would seem. And journals need to fill their pages.

BobNP said...

Two of the most ridiculous statements I"ve seen in medical papers: (I am paraphrasing from memory -these were written years ago) "Fatal asthma differs from non-fatal asthma" and "If patient who died were excluded from the analysis, the survival rate was 100%" Not making this up!

Skeptical Scalpel said...

Bob, great comment. I would love to see the papers those statements appeared in.

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