Consequences of Emergency Department overcrowding

Consequences of ED overcrowding

ED overcrowding is a major problem significantly linked to:

  • More frequent death or adverse cardiovascular outcomes (AMI, heart failure, hypotension, dysrhythmias, or cardiac arrest not seen at presentation, but occurring during an inpatient stay) in patients hospitalized for chest pain or related possibly cardiac complaints Ref‑1
  • Increased mortality at 2 days Ref-2, 7 days Ref‑2, Ref‑3 and 30 days Ref‑2
  • Decreased adherence to guideline–recommended therapies and higher risk of recurrent MI in patients with non-ST-segment elevation myocardial infarction (NSTEMI) Ref‑4
  • Delayed intravenous thrombolysis in patients with suspected AMI Ref‑5

Rapid AMI rule-out with Copeptin

Rapid AMI rule-out with Copeptin

By sparing most patients unneeded serial Tn testing requiring protracted ED waits Ref‑6, rapid AMI rule-out via Copeptin + Tn testing potentially could help relieve ED overcrowding.

For these reasons, BIC-8, the first interventional study of the Copeptin + Troponin rapid AMI rule-out strategy, has been termed “…an extremely important endeavor that is necessary to bridge the gap towards changing practice…” Ref‑7

References Benefits of Copeptin

Ref-1: Pines JM, Pollack CV, Jr., Diercks DB et al. The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med 2009; 16: 617-625 DOI: 10.1111/j.1553-2712.2009.00456.x

Ref-2: Sprivulis PC, Da Silva JA, Jacobs IG et al. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 2006; 184: 208-212 DOI: spr10395_fm [pii]

Ref-3: Guttmann A, Schull MJ, Vermeulen MJ et al. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011; 342: d2983 DOI: 10.1136/bmj.d2983

Ref-4: Diercks DB, Roe MT, Chen AY et al. Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med 2007; 50: 489-496 DOI: 10.1016/j.annemergmed.2007.03.033

Ref-5: Schull MJ, Vermeulen M, Slaughter G et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med 2004; 44: 577-585 DOI: 10.1016/S0196064404005232

Ref-6: Mockel M, Searle J, Hamm C et al. Early discharge using single cardiac Troponin and Copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J 2014: DOI: 10.1093/eurheartj/ehu178

Ref-7: Gandhi PU, Januzzi JL, Jr. Can Copeptin emerge from the growing shadow of the Troponins? Eur Heart J 2014: DOI: 10.1093/eurheartj/ehu211