OHSU Study: Increasing ICU Beds Eases Ambulance Diversion

03/04/05    Portland, Ore.

Emergency medicine researchers at Oregon Health & Science University have found that increasing the number of intensive care unit beds alleviates some aspects of emergency department overcrowding, according to a new study.

The findings address a national problem that impacts quality of care, and results in ambulance diversions, long waiting times, and patients leaving without being seen by a doctor. They are reported today in a study to be published in the early online edition of Annals of Emergency Medicine.

Researchers found that when OHSU Hospital added 20 ICU beds, increasing its total to 67, the average number of hours each day its emergency department had to divert ambulances dropped from 3.8 hours to 1.4 hours, a 66 percent decrease. Changes in the average length of stay in the emergency department were less dramatic. The largest length-of-stay decrease occurred among patients awaiting an ICU bed, whose time spent in the emergency department decreased by about 25 minutes - from 257 to 232 minutes.

However, the average length of stay in the emergency department did not significantly decrease for other admitted patients or for the large majority (70 percent) of emergency patients who were discharged home.

According to the study's authors, to reduce costs, hospitals today operate fewer inpatient beds than they did a decade ago. Between 1990 and 1999, hospitals lost 103,000 staffed beds and 7,800 medical/surgical ICU beds. As a result, there are fewer beds to accommodate admissions from the emergency department. Ambulance diversion occurs when all of the emergency department beds are filled with very sick or injured patients and the hospital cannot safely accept one more ambulance patient.

"Although emergency department crowding has been on the rise nationally, few hospitals have expanded ICU capacity to meet demand," said first author K. John McConnell, Ph.D., with the OHSU Center for Policy & Research in Emergency Medicine. "Our study provides evidence that ambulance diversions are linked to the shortage of beds in the hospital. Ambulance diversions are of concern because they may place the patient at risk for poor outcome and prolonged pain and suffering."

McConnell said researchers "were surprised that the increase in ICU capacity did not translate into larger decreases in emergency department length of stay. However, the ICU bottleneck might be a more significant problem in states like California, where emergency department length of stay can be considerably longer than in Oregon, where this study was conducted."

Study authors suggest that as an alternative to adding expensive ICU beds, some hospitals have chosen to adopt more flexible strategies that decrease the amount of time patients are boarded in the emergency department. Such strategies might include employing hospitalists, incorporating bed utilization committees, increasing nursing and physician staffing ratios, and changing emergency department procedures to improve patient flow.

Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical society representing physicians specializing in emergency medicine. With more than 23,000 members, ACEP is committed to improving the quality of emergency care through continuing education, research and public education. For more information, visit www.acep.org/AnnEmergMed.