181: Following Volume Trends Throughout the Country Using the Emergency Department Benchmarking Alliance Database

Abstract

To compare emergency department (ED) admission percentage, mean ED length of stay (LOS), and percentage of patients who leave before treatment is complete (LBTC) among various volume EDs using data from the Emergency Department Benchmarking Alliance (EDBA) database. A retrospective analytic cohort study examining selected data points from the EDBA database was conducted. The EDBA consists of 86 hospitals in 2005, 84 in 2006, 85 in 2007, and 86 in 2008, with EDs ranging in size from under 25,000 to over 100,000 visits per year. The EDBA database contains operational data submitted by member hospitals on a yearly basis. Data from 2004-2008 were included in this study. EDs were grouped into 3 categories by volume: <25,000 visits/yr (low volume), 25,000-60,000 visits/yr (medium volume), and > 60,000 visits/yr (high volume). ED admission percentage, mean ED LOS, and % LBTC were compared among the 3 groups using analysis of variance (ANOVA). A p-value ≤ 0.05 was considered significant. ED admission % was higher in the high volume EDs than in the medium and low volume EDs (24.2% ± 6.4 versus 17.6% ± 6.4 versus 10.6%± 7, p<0.01). Mean ED LOS for admitted patients was higher in the high volume EDs (385 min ± 106 versus 314 min ± 95 versus 223 min ± 52, p<0.01). Mean ED LOS for discharged patients was also higher for high volume EDs (202 min ± 45 versus 161 min ± 47 versus 108 min ± 32, p<0.01). Finally, the % LBTC was higher in the high volume EDs than in the medium and low volume EDs (3.1% ± 1.7 versus 2.9%± 1.9 versus 1.5% ± 1.1, p<0.01). ED admission percentage, ED LOS, and % LBTC were higher in high volume EDs when compared with medium and low volume EDs. A possible explanation being since high volume EDs have a higher admission percentages - suggesting higher acuity - the mean length of stay can be expected to be longer. That longer length of stay can therefore lead to a higher %LBTC. Going forward, continued research must be done to further elucidate the causes of these trends.