Effect of increased icu capacity on length of stay in the emergency department

Study objectives: The lack of inpatient bed availability has been identified as a major contributor to emergency department (ED) crowding. The objective of this study is to determine the change in ED length of stay that occurred in an urban, academic medical center following an increase in adult ICU beds. Methods: This was a secondary analysis of hospital administrative data on 74,641 patients who visited the ED between July 1, 2001, and December 31, 2003. Multivariate analysis was used to assess the change in length of stay for patients admitted to the ICU, patients admitted to ward units, and patients discharged home. Our analysis adjusted for patient demographics and acuity, time of visit, total patient load within the ED, and ICU and ward occupancy rates. Results: Before August 7, 2002, the hospital had 47 adult ICU beds and 411 total inpatient beds. The median occupancy rate for ICU beds was 90%. On August 7, 2002, the number of adult ICU beds increased from 47 to 67, increasing total hospital beds from 411 to 431. Median ICU daily occupancy rates decreased to 75% between August 7, 2002, and January 31, 2002. Excluding transfers and patients admitted to observation units, 1,834 patients were admitted to the ICU, 8,073 were admitted to the ward, and 64,734 patients were discharged home. ED length of stay for patients admitted to the ICU decreased from 177.4 minutes to 153.9 minutes, a reduction of 23.5 minutes (95% confidence interval [CI] −33.6 to −15.1). ED length of stay for patients admitted to the ward decreased from 366.9 minutes to 351.4 minutes, a reduction of 15.5 minutes (95% CI −22.1 to −8.9). ED length of stay for patients discharged home increased slightly, from 154.2 minutes to 156.6, an increase of 2.4 minutes (95% CI 3.4 to 1.7). Reductions in ED length of stay for admitted patients were almost entirely caused by decreases in the length of time required for bed assignment after a bed request was made and not a result of changes in triage time or clinical evaluation time. Conclusion: Increased ICU bed capacity led to reduced occupancy rates for ICU beds. Reduced occupancy contributed to substantial reductions in ED length of stay for patients admitted to the ICU and ward units. Improving inpatient bed availability may be useful in alleviating ED crowding and reducing ED length of stay.