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Background <p>In-hospital cardiac arrest (IHCA) is a critical event often preceded by signs of clinical deterioration. Emergency department (ED) overcrowding may compromise timely monitoring and intervention and may be associated with a higher occurrence of IHCA. The ED bed occupancy rate (EDBOR) is a quantifiable indicator of crowding. This study aimed to examine the association between EDBOR and the occurrence of IHCA in the ED.</p> Methods <p>We conducted a retrospective observational study at Thammasat University Hospital from January 2020 to December 2022. EDBOR at the time of IHCA was compared with EDBOR during routine ED operations using a case–control analogue design, with time points as the unit of analysis. Logistic regression was used to assess the association between EDBOR and IHCA occurrence, with additional sensitivity analyses across high-occupancy thresholds.</p> Results <p>During the three-year study period, 54,951 ED visits were recorded. EDBOR at the time of 125 IHCA events and 3,285 control time points was analyzed. Although the mean EDBOR at the time of IHCA was slightly higher than during control periods (75.5% vs. 70.5%), this difference was not statistically significant (<i>p</i> = 0.275). Sensitivity analyses across multiple EDBOR thresholds (at least 40%, 50%, 60%, 70%, and 80%) demonstrated a graded association, with a consistently higher likelihood of IHCA at higher occupancy levels. Among time points with EDBOR at least 60%, each 10–percentage-point increase in EDBOR was associated with a 10% increase in the odds of IHCA (adjusted odds ratio 1.10; 95% confidence interval 1.01 to 1.18; <i>p</i> = 0.02).</p> Conclusion <p>Elevated EDBOR was significantly associated with an increased occurrence of IHCA in the ED. While causality cannot be inferred from this observational study and the findings should be considered hypothesis-generating, monitoring EDBOR during high-occupancy periods may help inform crowding mitigation strategies and departmental planning, pending validation in future studies.</p>

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Association between emergency department bed occupancy rate and in-hospital cardiac arrest in the emergency department: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月3日

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  • Kiattichai Daorattanachai,
  • Kornrawee Srisiri,
  • Winchana Srivilaithon,
  • Chitlada Limjindaporn,
  • Kumpol Kornthatchapong,
  • Intanon Imsuwan,
  • Ittabud Dasanadeba,
  • Nipon Diskumpon

摘要

Background

In-hospital cardiac arrest (IHCA) is a critical event often preceded by signs of clinical deterioration. Emergency department (ED) overcrowding may compromise timely monitoring and intervention and may be associated with a higher occurrence of IHCA. The ED bed occupancy rate (EDBOR) is a quantifiable indicator of crowding. This study aimed to examine the association between EDBOR and the occurrence of IHCA in the ED.

Methods

We conducted a retrospective observational study at Thammasat University Hospital from January 2020 to December 2022. EDBOR at the time of IHCA was compared with EDBOR during routine ED operations using a case–control analogue design, with time points as the unit of analysis. Logistic regression was used to assess the association between EDBOR and IHCA occurrence, with additional sensitivity analyses across high-occupancy thresholds.

Results

During the three-year study period, 54,951 ED visits were recorded. EDBOR at the time of 125 IHCA events and 3,285 control time points was analyzed. Although the mean EDBOR at the time of IHCA was slightly higher than during control periods (75.5% vs. 70.5%), this difference was not statistically significant (p = 0.275). Sensitivity analyses across multiple EDBOR thresholds (at least 40%, 50%, 60%, 70%, and 80%) demonstrated a graded association, with a consistently higher likelihood of IHCA at higher occupancy levels. Among time points with EDBOR at least 60%, each 10–percentage-point increase in EDBOR was associated with a 10% increase in the odds of IHCA (adjusted odds ratio 1.10; 95% confidence interval 1.01 to 1.18; p = 0.02).

Conclusion

Elevated EDBOR was significantly associated with an increased occurrence of IHCA in the ED. While causality cannot be inferred from this observational study and the findings should be considered hypothesis-generating, monitoring EDBOR during high-occupancy periods may help inform crowding mitigation strategies and departmental planning, pending validation in future studies.