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The influence of emergency department crowding on the efficiency of care for acute stroke patients.

Objective
To investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients.


Design
Retrospective cohort study conducted from 1 May 2008 to 31 December 2013.


Setting
Largest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan.


Participants
Patients aged 18-80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142).


Main Outcome Measures
Door-to-assessment time (DTA), door-to-computed tomography completion time (DTCT) and door-to-needle time (DTN).


Results
Of the 785 patients with ischemic stroke, 90 (11.46%) received thrombolysis. In the multivariate regression analysis, the number of ED patients and the number of attending physicians were significantly associated with delayed DTA and DTCT but not DTN. Initial assessment by a resident was also associated with delayed DTA and DTCT. The number of nurses was associated with delayed DTCT and DTN.


Conclusions
Although ED crowding was not associated with delayed DTN, it predicted delayed DTA and DTCT in thrombolysis-eligible stroke patients. The number of attending physicians affected initial assessment and DTCTs, whereas the number of nurses impacted thrombolytic administration times.