Dataset Information

Emergency Department Length of Stay and Outcome after Ischemic Stroke.

ABSTRACT:

Background

Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke.

Methods

This study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score >2), respectively.

Results

The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n = 160) versus the neuroscience intensive care unit (NICU; n = 165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P <.001), endovascular stroke therapy (P = .001), and thrombolysis (P = .021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P = .048). On multivariable logistic regression, a greater admission National Institutes of Health Stroke Scale score (P <.001), worse preadmission mRS score (P = .001), hemorrhagic conversion (P = .041), and a shorter ED-LOS (P = .016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P = .049), endovascular stroke therapy (P = .041), NICU admission (P = .029), and evening shift presentation (P = .035) were associated with a good 90-day outcome.

Conclusions

In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk of a poor functional outcome.

SUBMITTER: Minaeian A

PROVIDER: S-EPMC5600670 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Emergency Department Length of Stay and Outcome after Ischemic Stroke.

Minaeian Artin A Patel Anand A Essa Basad B Goddeau Richard P RP Moonis Majaz M Henninger Nils N

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 20170524 10

<h4>Background</h4>Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke.<h4>Methods</h4>This study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression ...[more]

PMID: 28551289

Similar Datasets

Project description:IntroductionIschemic stroke is the second leading cause of mortality and a major contributor to disability worldwide. Hospital length of stay (LOS) is a marker of medical efficiency for stroke care. There is limited information on this issue in China. This study aimed to identify predictors of prolonged LOS and to assess whether a prolonged LOS benefits functional outcomes in patients with acute ischemic stroke (AIS) in China.MethodsThis secondary analysis of the Chinese Acute Ischemic Stroke Treatment Outcome Registry, a multicenter, prospective, hospital-based registry study, included patients diagnosed as AIS and admitted to a hospital within 3 days after AIS onset from May 2015 to October 2017. Participants were dichotomized as the normal LOS group (LOS ≤ 14 days) and the prolonged LOS group (LOS > 14 days). The outcomes were the proportions of poor outcome at 3 months and 12 months after stroke onset. Poor outcome was defined as a mRS score of 3-6.ResultsThis study included 8171 patients (median age 64.0 years; 5367 male, 2804 female); 2968 (36.3%) patients had a prolonged LOS. Multivariable analysis identified independent predictors of prolonged LOS, including medical insurance, history of diabetes mellitus, stroke severity, use of anticoagulant agents, in-hospital infection complications, hemorrhagic events, and hospital region. A prolonged LOS was associated with a higher risk of poor outcome at 3 and 12 months after stroke, with this finding upheld in a propensity score-matched cohort as well as subgroup analyses stratified by stroke severity and age.ConclusionIn this study, approximately one-third of patients with AIS experienced a prolonged LOS over 14 days. Independent predictors of prolonged LOS included medical insurance, history of diabetes mellitus, stroke severity, use of anticoagulant agents, in-hospital infection complications, hemorrhagic events, and hospital region. Extending the LOS beyond 14 days did not enhance the prognosis for patients with AIS. As an observational study, our research provided the foundation for further interventional studies. Graphical abstract available for this article.Trial registrationClinicalTrials.gov NCT02470624.

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.

Project description:Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8-66.6) to 10.2 (5.7-18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2-84.7) to 10.5 (5.9-18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1-5.3) to 3.7 (2.3-5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8-1.8) to 0.3 (0.2-0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology, anticipating that it may be better for the downstream physician to have more information rather than less.

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.

Dataset Information

Emergency Department Length of Stay and Outcome after Ischemic Stroke.

Background

Methods

Results

Conclusions

Publications

Emergency Department Length of Stay and Outcome after Ischemic Stroke.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets