Relative effects of external and internal factors on emergency department efficiency

BACKGROUND: TO know the relative effect of external and internal factors on emergency department (ED) efficiency. PATIENTS AND METHOD: Along 3 consecutive weeks we compute at 3 hours-interv al the number or patient waiting for visit and the mean waiting time for vi sit (efficiency markers), the number of patients arriving to ED (external p ressure marker) and the number of patients remaining in ED after beginning the visit (internal pressure marker), which was divided in ED-related facto rs, hospital-related factors, ED-hospital interelation-related factors, or not caused by ED nor hospital-related factors. RESULTS: Only the increase of internal pressure was associated with a decli ne in ED efficiency (p < 0.001). ED-related and hospital-related factors we re those significantly associated with such a decline (p < 0.05 and p < 0.0 1, respectively). CONCLUSION: Internal pressure generated by the own ED exerts a prominent ro le in its dysfunction; therefore, policies addressed to reduce such interna l pressure should be encouraged.