Dataset Information

Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

ABSTRACT:

Study objective

To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).

Methods

A retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of internal medicine patients <65 years old were included. Organisational factors were defined as non-medical factors. ED-LOS is defined as the time between ED arrival and ED discharge or admission. Prolonged ED-LOS is defined as ?75th percentile of ED-LOS in the study population, which was 208 minutes.

Results

Data on 1782 emergency department visits by elderly patients and 597 emergency department visits by younger patients were analysed. Prolonged ED-LOS in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3-4.3), a higher number of diagnostic tests (OR 1.2, 95% CI 1.16-1.33) and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0-8.8 and OR 2.3, 95% CI 1.4-3.9). In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4-4.6). Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.

Conclusion

Organisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.

SUBMITTER: Brouns SH

PROVIDER: S-EPMC4534295 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

Brouns Steffie H A SH Stassen Patricia M PM Lambooij Suze L E SL Dieleman Jeanne J Vanderfeesten Irene T P IT Haak Harm R HR

PloS one 20150812 8

<h4>Study objective</h4>To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).<h4>Methods</h4>A retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of intern ...[more]

PMID: 26267794

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Project description:BackgroundA prolonged length of stay in an emergency department is related to lower quality of care and adverse outcomes, which are often linked with overcrowding.ObjectiveExamine the influence of demographic factors on prolonged length of stay in the emergency department.MethodsThis study used a cross-sectional design. It used secondary data for all patients admitted during the specific duration at the emergency department of a governmental hospital in Saudi Arabia. The independent variables were gender, age, disposition status, shift time, and clinical acuity (CTAS) level while the dependent variable was prolonged length of stay.ResultsThe study shows that 30% of patients stay at the emergency department for four hours or more. The results also show a significant association between demographic factors which are age, gender, disposition status, shift time, clinical acuity (CTAS) level and prolonged length of stay in an emergency department. Based on the results males are more likely to stay in the emergency department than females (OR = 1.20; 95% CI = 1.04 to 1.38). Patients aged 60 and older are less likely to stay in the emergency department than patients aged 29 or smaller (OR = 0.58; 95% CI = 0.39 to 0.84). According to disposition status discharged patients after examination stays in the emergency department more than admitted patients after the examination (OR = 2.78; 95% CI = 1.67 to 4.99). Patients who come to the night shift are less likely to stay in the emergency department than patients who come in the morning shift (OR = 0.67; 95% CI = 0.56 to 0.81). Patients who are classified in level three of CTAS are less likely to stay in the emergency department than patients who are classified in level one (OR = 0.28; 95% CI = 0.88 to 0.023).ConclusionDemographic factors such as age, gender, shift time, disposition status and clinical acuity (CTAS) were important factors that needed to be considered to reduce the length of stay of patients in the emergency department. it is possible to formulate a machine learning model to predict the anticipated length of stay in the hospital for each patient. This prediction with an accepted margin of uncertainty will help the clinicians to communicate the evidence-based anticipated length of stay with the patient's caregivers. In addition, hospital managers need to provide the emergency department with enough staff and materials to reduce the length of stay of patients.

Project description:Performance measures, particularly pay for performance, may have unintended consequences for safety-net institutions caring for disproportionate shares of Medicaid or uninsured patients.To describe emergency department (ED) compliance with proposed length-of-stay measures for admissions (8 hours or 480 minutes) and discharges, transfers, and observations (4 hours or 240 minutes) by safety-net status.The 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS) ED data were stratified by safety-net status (Centers for Disease Control and Prevention definition) and disposition (admission, discharge, observation, transfer). The 2008 NHAMCS is a national probability sample of 396 hospitals (90.2% unweighted response rate) and 34 134 patient records. Visits were excluded for patients younger than 18 years, missing length-of-stay data or dispositions of missing, other, left against medical advice, or dead on arrival. Median and 90th percentile ED lengths of stay were calculated for each disposition and admission/discharge subcategories (critical care, psychiatric, routine) stratified by safety-net status. Multivariable analyses determined associations with length-of-stay measure compliance.Emergency Department length-of-stay measure compliance by disposition and safety-net status.Of the 72.1% ED visits (N = 24 719) included in the analysis, 42.3% were to safety-net EDs and 57.7% were to non-safety-net EDs. The median length of stay for safety-net was 269 minutes (interquartile range [IQR], 178-397 minutes) for admission vs 281 minutes (IQR, 178-401 minutes) for non-safety-net EDs; 156 minutes (IQR, 95-239 minutes) for discharge vs 148 minutes (IQR, 88-238 minutes); 355 minutes (IQR, 221-675 minutes) for observations vs 298 minutes (IQR, 195-440 minutes); and 235 minutes (IQR, 155-378 minutes) for transfers vs 239 minutes (IQR, 142-368 minutes). Safety-net status was not independently associated with compliance with ED length-of-stay measures; the odds ratio was 0.83 for admissions (95% CI, 0.52-1.34); 1.03 for discharges (95% CI, 0.83-1.27); 1.05 for observations (95% CI, 0.57-1.95), 1.30 for transfers (95% CI, 0.70-2.45]); or subcategories except for psychiatric discharges (1.67, [95% CI, 1.02-2.74]).Compliance with proposed ED length-of-stay measures for admissions, discharges, transfers, and observations did not differ significantly between safety-net and non-safety-net hospitals.

Dataset Information

Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

Study objective

Methods

Results

Conclusion

Publications

Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

Similar Datasets

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