Influence of available resources on medical practitioners' decision-making process and practice: study of a reference hospital emergency department.

OBJECTIVE: To evaluate variations in the observation period in the emergency department (ED) in response to bed availability. METHODS: A quasi-experimental pre-test post-test study without a control group was conducted in the ED observation ward over 2 1-month periods. During this time the only variable that changed was the number of beds available, which decreased from 20 (pre-test period) to 16 (post-test period). RESULTS: The ED attended 7,725 patients: 3,706 patients in pre-test period, 335 of whom were admitted to the observation ward, with an average length of stay of 1,105.4 minutes per patient, and 4,019 patients in post-test period, 570 of whom were admitted to the observation ward, with an average length of stay of 686.1 minutes per patient (p < 0.001). There was no variation in mortality, re-admissions or complaints. CONCLUSIONS: A reduction in bed availability for observation purposes shortens patient length of stay.

Influence of available resources on medical practitioners' decision-making process and practice: study of a reference hospital emergency department

Objetivo: Evaluar la variación del indicador "periodo de tiempo de observación" dedicado a cada paciente, en respuesta a una reducción del número de camas disponibles. Métodos: Se realizó un estudio «quasiexperimental preprueba postprueba» sin grupo control en una unidad de urgencias durante 2 períodos de un mes. En este tiempo el único cambio fue el número de camas disponibles, que disminuyeron de 20 (período A) a 16 (período B). Resultados: El servicio de urgencias atendió a 7.725 pacientes: 3.706 pacientes en el período A, 335 de los cuales fueron admitidos en la unidad de observación con una estancia media de 1.105,4 minutos por paciente; y 4.019 pacientes en el período B, 570 de los cuales fueron admitidos en la unidad de observación con una estancia media de 686,1 minutos por paciente (p < 0,001). No hubo variaciones en la mortalidad, readmisiones o quejas. Conclusiones: Una disminución en el número de camas disponibles para observación comporta una reducción en el tiempo de estancia de los pacientes

Objective: To evaluate variations in the observation period in the emergency department (ED) in response to bed availability. Methods: A quasi-experimental pre-test post-test study without a control group was conducted in the ED observation ward over 2 1-month periods. During this time the only variable that changed was the number of beds available, which decreased from 20 (pre-test period) to 16 (post-test period). Results: The ED attended 7,725 patients: 3,706 patients in pre-test period, 335 of whom were admitted to the observation ward, with an average length of stay of 1,105.4 minutes per patient, and 4,019 patients in post-test period, 570 of whom were admitted to the observation ward, with an average length of stay of 686.1 minutes per patient (p < 0.001). There was no variation in mortality, re-admissions or complaints. Conclusions: A reduction in bed availability for observation purposes shortens patient length of stay