Page 381 - Week 02 - Tuesday, 7 March 2006
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“Increase in patient mortality at 10 days associated with emergency department overcrowding” by Associate Professor Drew Richardson makes for some startling reading. The accompanying editorial “Hospital overcrowding, a threat to patient safety?” by Professor Peter Cameron puts Richardson’s research into its proper context. Professor Richardson opens his article by writing:
Overcrowding causes dysfunction in the emergency department (ED): it is associated with longer waiting times, increased delays in admission to hospital, and even with transmission of infectious disease (during the outbreak of severe acute respiratory diseases [SARS] in Canada). Delays in transfer to an inpatient bed from the ED are associated with increased inpatient length of stay, but there have been few studies of the relationship between ED overcrowding and patient outcomes. An understanding of the human cost of overcrowding is important to guide appropriate distribution of health care resources.
I emphasise that last point:
An understanding of the human cost of overcrowding is important to guide appropriate distribution of health care resources.
As we know, the last thing this government or this minister cares about is the human cost of its policies. While I will not bore members by reading the whole article here, you can access it online at www.mja.com.au. I will quote the important findings:
• The cohort of patients presenting when the ED was overcrowded has significantly higher 10-day in-hospital mortality than a similar cohort treated when the ED was not overcrowded, stratified for shift, day, season and year;
• More patients presented during Over Crowded shifts, they were triaged as having slightly higher acuity, and they received care at a much lower performance level by standard measures;
• Physical and staff capacity is reached or exceeded at times of ED overcrowding, and it is plausible that patients presenting at these times receive a lower quality of care because the available resources are stretched too thinly;
• ED overcrowding is caused by insufficient available inpatient beds access block, or high hospital occupancy;
• Patients presenting during times of increased ED occupancy were reasonably similar to those presenting at other times, but had significantly higher short-term in-hospital mortality; and
• The magnitude of the association is around 13 excess in-hospital deaths annually, similar to the number of people killed on the roads in the ACT.
What Richardson’s research shows is that there are 13 extra deaths each year in the ACT that are statistically associated with hospital overcrowding. While Richardson does not state outright that hospital overcrowding causes an extra 13 hospital deaths in each
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