Factors associated with emergency department length of stay of internal medicine patients
https://doi.org/10.4081/ecj.2021.9570
Accepted: 30 April 2021
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Emergency Department (ED) Length Of Stay (ED-LOS) is associated with quality of care, patient safety and treatment outcome. The aim of this study is to identify factors associated with ED-LOS of internal medicine patients and provide recommendations to shorten ED-LOS. A retrospective cohort study was conducted in a single center in the Netherlands. Anonymised data of 7,380 ED attendances from January 2016 to January 2018 were analyzed. Data included time of ED arrival and departure, sex, age, source of referral, triage category, first or consecutive visit and number of radiological examinations. Univariate analyses were used. Mean ED-LOS was 220 minutes. Factors which significantly prolonged ED-LOS were older age, source of referral, triage category, need for admission, first visit, number of radiological examinations, presentation in winter or spring and time of arrival (day and evening). Several patient and circumstantial factors are associated with ED-LOS. To shorten ED-LOS, we recommend to anticipate need for admission for older patients who arrive by ambulance and to create time slots in the radiology program and to restructure the morning report.
Taylor C, Benger JR. Patient satisfaction in emergency medicine. Emerg Med J 2004;21:528-32 DOI: https://doi.org/10.1136/emj.2002.003723
Singer AJ, Thode HC, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med 2011;18:1324-9 DOI: https://doi.org/10.1111/j.1553-2712.2011.01236.x
Liew D, Liew D, Kennedy MP. Emergency department length of stay independently predicts excess inpatient length of stay. Med J Australia 2003;179:524-6. DOI: https://doi.org/10.5694/j.1326-5377.2003.tb05676.x
Hobbs D, Kunzman SC, Tandberg D, Sklar D. Hospital factors associated with emergency center patients leaving without being seen. Am J Emerg Med 2000;18:767-72. DOI: https://doi.org/10.1053/ajem.2000.18075
Bashkin O, Caspi S, Haligoa R, et al. Organizational factors affecting length of stay in the emergency department: Initial observational study. Isr J Health Policy 2015;4:38. DOI: https://doi.org/10.1186/s13584-015-0035-6
Falvo T, Grove L, Stachura R, et al. The opportunity loss of boarding admitted patients in the emergency department. Acad Emerg Med 2007;14:332-7. DOI: https://doi.org/10.1197/j.aem.2006.11.011
Foley M, Kifaieh N, Mallon WK. Financial impact of emergency department crowding. West J Emerg Med 2011;12:192-7.
Schreyer K, Martin R. The economics of an admissions holding unit. West J Emerg Med 2017;18:553-8. DOI: https://doi.org/10.5811/westjem.2017.4.32740
McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med 2009;54:492-503. DOI: https://doi.org/10.1016/j.annemergmed.2009.03.006
Banerjea K, Carter AO. Waiting and interaction times for patients in a developing country accident and emergency department. Emerg Med J 2006;23:286-90. DOI: https://doi.org/10.1136/emj.2005.024695
Bobrovitz N, Lasserson DS, Briggs ADM. Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England. BMC Emerg Med 2017;17:32. DOI: https://doi.org/10.1186/s12873-017-0145-2
Brick C, Lowes J, Lovstrom L, et al. The impact of consultation on length of stay in tertiary care emergency departments. Emerg Med J 2014;31:134-8. DOI: https://doi.org/10.1136/emermed-2012-201908
Brouns SHA, Stassen PM, Lambooij SLE et al. Organisational factors induce prolonged emergency department length of stay in elderly patients - A retrospective cohort study. PLOS One 2015;10:e0135066. DOI: https://doi.org/10.1371/journal.pone.0135066
Gardner RL, Sarkar U, Maselli JH, Gonzales R. Factors associated with longer ED lengths of stay. Am J Emerg Med 2007;25:643-50. DOI: https://doi.org/10.1016/j.ajem.2006.11.037
Hosseininejad SM, Aminiahidashti H, Pashaei SM, et al. Determinants of prolonged length of stay in the emergency department; a cross-sectional Study. Emergency 2017;5:e53.
Thijssen WAMH, Kraaijvanger N, Barten DG, et al. Impact of a well-developed primary care system on the length of stay in emergency departments in the Netherlands: A multicenter study. BMC Health Serv Res 2016;16:149. DOI: https://doi.org/10.1186/s12913-016-1400-z
Vegting IL, Alam N, Ghanes K, et al. What are we waiting for? Factors influencing completion times in an academic and peripheral emergency department. Neth J Med 2015;73:331-40.
Vegting IL, Nanayakkara PWB, van Dongen AE, et al. Analysing completion times in an academic emergency department: Coordination of care is the weakest link. Neth J Med 2011;69:392-8
Casalino E, Wargon M, Peroziello A, et al. Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact of age, patient’s clinical acuity and complexity, and care pathways. Emerg Med J 2014;31:361-8. DOI: https://doi.org/10.1136/emermed-2012-202155
Rathlev NK, Chessare J, Olshaker J, et al. Time series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med 2007;49:265-71. DOI: https://doi.org/10.1016/j.annemergmed.2006.11.007
Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008;52:126-36. DOI: https://doi.org/10.1016/j.annemergmed.2008.03.014
Nederlandse Triage Standaard. Basisprincipes NTS. 2014. Accessed 2020 June 18. Available from: https://de-nts.nl/nts/basisprincipes-nts/
Field A. Discovering statistics using SPSS. Sage Publication. 2009.
Van Der Linden C, Reijnen R, Derlet RW, et al. Emergency department crowding in the Netherlands: Managers’ experiences. Int J Emerg Med 2013;6:41. DOI: https://doi.org/10.1186/1865-1380-6-41
Erenler AK, Akbulut S, Guzel M, et al. Reasons for overcrowding in the emergency department: Experiences and suggestions of an education and research hospital. Turk J Emerg Med 2016;14:59-63. DOI: https://doi.org/10.5505/1304.7361.2014.48802
Amina S, Barrati A, Sadeghifar J, et al. Measuring and analyzing waiting time indicators of patients’ admitted in emergency department: a case study. Glob J Health Sci 2015;8:143-9. DOI: https://doi.org/10.5539/gjhs.v8n1p143
Cooke MW, Wilson S, Halsall J, Roalfe A. Total time in English accident and emergency departments is related to bed occupancy. Emerg Med J 2004;21:575-6. DOI: https://doi.org/10.1136/emj.2004.015081
Forster AJ, Stiell I, Wells G, et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003;10:127-33. DOI: https://doi.org/10.1197/aemj.10.2.127
CDC. Who is at high risk for flu complications? [Internet] Centers for Disease Control and Prevention. 2017 [cited 2020 June 18]. Available from: https://www.cdc.gov/flu/highrisk/index.htm
Bucheli B, Martina B. Reduced length of stay in medical emergency department patients: a prospective controlled study on emergency physician staffing. Eur J Emerg Med 2004;11:29-34. DOI: https://doi.org/10.1097/00063110-200402000-00006
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