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{
    "pk": 14538,
    "title": "Are Smaller Emergency Departments More Prone to  Volume Variability?",
    "subtitle": null,
    "abstract": "Introduction:\n Daily patient volume in emergency departments (ED) varies considerably between days and sites. Although studies have attempted to define “high-volume” days, no standard definition exists. Furthermore, it is not clear whether the frequency of high-volume days, by any definition, is related to the size of an ED. We aimed to determine the correlation between ED size and the frequency of high-volume days for various volume thresholds, and to develop a measure to identify high-volume days.\nMethods:\n We queried retrospective patient arrival data including 1,682,374 patient visits from 32 EDs in 12 states between July 1, 2018–June 30, 2019 and developed linear regression models to determine the correlation between ED size and volume variability. In addition, we performed a regression analysis and applied the Pearson correlation test to investigate the significance of median daily volumes with respect to the percent of days that crossed four volume thresholds ranging from 5–20% (in 5% increments) greater than each site’s median daily volume.\nResults:\n We found a strong negative correlation between ED median daily volume and volume variability (R2 = 81.0%; P < 0.0001). In addition, the four regression models for the percent of days exceeding specified thresholds greater than their daily median volumes had R2 values of 49.4%, 61.2%, 70.0%, and 71.8%, respectively, all with P < 0.0001.\nConclusion:\n We sought to determine whether smaller EDs experience high-volume days more frequently than larger EDs. We found that high-volume days, when defined as days with a count of arrivals at or above certain median-based thresholds, are significantly more likely to occur in lower-volume EDs than in higher-volume EDs. To the extent that EDs allocate resources and plan to staff based on median volumes, these results suggest that smaller EDs are more likely to experience unpredictable, volume-based staffing challenges and operational costs. Given the lack of a standard measure to define a high-volume day in an ED, we recommend 10% above the median daily volume as a metric, for its relevance, generalizability across a broad range of EDs, and computational simplicity.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Emergency Department, Staffing, Volume, Variability"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/650424cz",
    "frozenauthors": [
        {
            "first_name": "Sara",
            "middle_name": "",
            "last_name": "Nourazari",
            "name_suffix": "",
            "institution": "California State University, Long Beach, Department of Health Care Administration, Long Beach, California; Co-first authors",
            "department": "None"
        },
        {
            "first_name": "Jonathan",
            "middle_name": "W.",
            "last_name": "Harding",
            "name_suffix": "",
            "institution": "Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Co-first authors",
            "department": "None"
        },
        {
            "first_name": "Samuel",
            "middle_name": "R.",
            "last_name": "Davis",
            "name_suffix": "",
            "institution": "LogixHealth, Inc., Bedford, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Ori",
            "middle_name": "",
            "last_name": "Litvak",
            "name_suffix": "",
            "institution": "LogixHealth, Inc., Bedford, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Stephen",
            "middle_name": "J.",
            "last_name": "Traub",
            "name_suffix": "",
            "institution": "Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island",
            "department": "None"
        },
        {
            "first_name": "Leon",
            "middle_name": "D.",
            "last_name": "Sanchez",
            "name_suffix": "",
            "institution": "Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2020-09-08T08:14:59+05:30",
    "date_accepted": "2020-09-08T08:14:59+05:30",
    "date_published": "2021-07-14T12:30:00+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14538/galley/7432/download/"
        }
    ]
}