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The effect of emergency department occupancy on the revisitation rate within seven days among patients discharged by triage.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968543 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-227X (Electronic) Linking ISSN: 1471227X NLM ISO Abbreviation: BMC Emerg Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Emergency Service, Hospital*/statistics & numerical data ; Triage*/statistics & numerical data ; Patient Discharge*/statistics & numerical data ; Patient Readmission*/statistics & numerical data ; Bed Occupancy*/statistics & numerical data; Humans ; Male ; Female ; Middle Aged ; Aged ; Adult ; Crowding ; Time Factors
    • Abstract:
      Background: Emergency department (ED) crowding has been repeatedly shown to affect patient outcomes negatively. However, there is limited research on its impact on patients immediately discharged by the triage team. This study aimed to evaluate the effect of ED occupancy level on the rates of ED revisitation and hospitalization within seven days among patients discharged or redirected by the triage team.
      Methods: An observational single-center study was conducted at the Tampere University Hospital ED from January 1, 2023, to December 31, 2024. The study population consisted of patients who were discharged or redirected by the ED triage team. These patients were divided into two groups: (1) patients who revisited the ED within seven days and (2) patients who did not return within seven days. A subgroup analysis focused on revisits that resulted in hospitalization. ED occupancy at the time of triage was considered as a predicting factor for revisitation and hospitalization. Age, sex, triage shift, and the updated Charlson Comorbidity Index (uCCI) were adjusted for in a multivariable logistic regression analysis.
      Results: Of the 180,267 ED visitors during the study period, 8.8% (n = 15,910) were discharged by the triage team. Of these, 8.7% (n = 1392) revisited the ED within seven days, and 16.2% (n = 225) of the revisiting patients were hospitalized. In the multivariable analyses, the highest quartile of ED occupancy was associated with an increased likelihood of ED revisitation (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.06-1.57). Older age was linked to both revisitation and hospitalization (OR for a 1-year increase 1.01 [95% CI: 1.01-1.02] and 1.02 [95% CI: 1.02-1.03], respectively). The uCCI score was also associated with revisitation and hospitalization (OR for a 1-point increase 1.13 [95% CI: 1.07-1.18] and 1.23 [95% CI: 1.13-1.33], respectively).
      Conclusions: The highest ED occupancy quartile was associated with a modestly increased likelihood of an ED revisit but not hospitalization within seven days after being discharged by the triage team. Furthermore, age and comorbidities were associated with both revisitation and hospitalization.
      Trial Registration: Clinical trial number: not applicable.
      (© 2025. The Author(s).)
    • Abstract:
      Declarations. Ethics approval and consent to participate: This study was performed in accordance with the Declaration of Helsinki. The Tampere University Hospital research director approved (research diary no. R24278) this retrospective register-based study. Finnish law states that patient consent and an ethics committee statement are not required, if there are no patient interventions [32]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
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    • Contributed Indexing:
      Keywords: Crowding; Discharge; Emergency department; Low acuity; Nonurgent; Occupancy; Redirect; Triage
    • Publication Date:
      Date Created: 20250815 Date Completed: 20250826 Latest Revision: 20250908
    • Publication Date:
      20260130
    • Accession Number:
      PMC12357415
    • Accession Number:
      10.1186/s12873-025-01315-8
    • Accession Number:
      40817037