Relationship between Emergency Department Crowding and Delay in Acute Stroke Management: A Prospective Observational Study
Wansiri Chaisirin MD1, Tipa Chakorn MD1, Nattakarn Prapruetkij MD1, Apichaya Monsomboon MD1, Usapan Surabenjawong MD1, Tanyaporn Nakornchai MD1, Sattha Riyapan MD1
Affiliation : 1 Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Patients with acute stroke should be treated promptly using fast-track management to decrease morbidity and mortality;
however, emergency department [ED] crowding may delay treatment. The authors ascertained the ef(cid:976)iciency of acute stroke
fast-track management by measuring the correlation between ED crowding (occupancy rate) and time from door to computed
tomography [CT] scan.
Materials and Methods : The present report was a prospective observational study including patients with acute stroke symptoms
within 4.5 hours after onset, whom were treated by following the acute stroke fast-track management. The occupancy rate was
used to represent ED crowding. The correlation between occupancy rate and timing for each step (time to neurologist/radiologist
noti(cid:976)ication, CT scan, blood laboratory report, or needle) was analyzed using Spearman’s correlation coef(cid:976)icients.
Results : Among the 94 patients studied, the medians of the door to CT scan, door to blood laboratory report, and door to (cid:976)ibrinolytic
drug administration times were 22 minutes (16 to 27.25), 73.5 minutes (63 to 89.25), and 75 minutes (57.5 to 89.5), respectively.
The median occupancy rate was 70% (50 to 100). There was no signi(cid:976)icant correlation between occupancy rate and door to CT
scan time (r = 0.184, p = 0.076) or door to (cid:976)ibrinolytic drug administration (r = 0.272, p = 0.233). However, there was a signi(cid:976)icant,
weak positive correlation between ED crowding and door to blood laboratory report time (r = 0.400, p<0.001).
Conclusion : ED crowding was not correlated with door to CT scan time. However, it was correlated with time to blood laboratory
report, which might affect acute stroke management.
Keywords : Emergency department, Crowding, Delay, Stroke care
