Patterns and Factors Associated with Intensive Utilization of Emergency Department Services : Implications for Allocating Resources

Aim: This study aims to better understand the patterns and factors associated with use of emergency department (ED) services on high volume and intensive (defined by high volume and high patient severity) days in order to improve resource allocation and reduce ED overcrowding. Methods: This study created a new index of “intensive utilization” based on volume and severity of illness and a three-part categorization (normal volume, high volume, intensive utilization) to measure stress in the ED environment. This retrospective, cross-sectional study collected data from hospital clinical and financial records of all patients seen in 2001 at an urban academic hospital ED. Results: Multivariate logistic regression models identified factors associated with high volume and intensive utilization, Factors associated with intensive days included being in a motor vehicle crash, having a gun or stab wound; arriving during months of January, April, May, or August, and arriving during days of Monday, Tuesday, or Wednesday. Factors associated with high volume days included falling from 0 to 10 feet, being in a motor vehicle crash, arriving during the months of January, April, May, or August, and arriving during days of Monday, Tuesday or Wednesday. Conclusion: These findings offer inputs for reallocating resources and altering staffing models to more efficiently provide high quality ED services and prevent overcrowding