Abstract
Background: Measuring and understanding main determinants of length of stay (LOS) in emergency departments (EDs) is critical from an operations perspective, since LOS is one of the main performance indicators of ED operations. Therefore, this study analyzes both the main and interaction effects of four widely-used independent determinants of ED-LOS. Methods: The analysis was conducted using secondary data from an ED of a large urban hospital in Izmir, Turkey. Between-subject factorial analysis of variance (ANOVA) was used to test the main and interaction effects of the corresponding factors. P values <.05 were considered statistically significant. Results: While the main effect of gender was insignificant, age, mode of arrival, and clinical acuity had significant effects, whereby ED-LOS was significantly higher for the elderly, those arriving by ambulance, and clinically-categorized high-acuity patients. Additionally, there was an interaction between the age and clinical acuity in that, while ED-LOS increased with age for high acuity patients, the opposite trend occurred for low acuity patients. When ED-LOS was modeled using gender, age, and mode of arrival, there was a significant interaction between age and mode of arrival. However, this interaction was not significant when the model included age, mode of arrival, and clinical acuity. Conclusion: Significant interactions exist between commonly used ED-LOS determinants. Therefore, interaction effects should be considered in analyzing and modelling ED-LOS.
Highlights
Emergency departments (EDs) are the most critical medical resource for delivering emergency services
These findings may provide additional information for practitioners starting from the triage process while classifying patients based on their clinical acuity levels, relevant ED staff, and the patient and/or relatives can be informed about estimated length of stay (LOS)
Estimated LOS values in each category can be used for planning, such as informing ambulance services regarding the number of high acuity patients requiring long stays, and efforts to persuade them to direct subsequent ambulances to another ED if possible
Summary
Emergency departments (EDs) are the most critical medical resource for delivering emergency services. Analyzing and reporting these factors have attracted significant attention recently
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