Abstract
IntroductionEmergency department length of stay (ED LOS) is currently used in Australasia as a quality measure. In our ED, Maori, the indigenous people of New Zealand, have a shorter ED LOS than European patients. This is despite Maori having poorer health outcomes overall. This study sought to determine drivers of LOS in our provincial New Zealand ED, particularly looking at ethnicity as a determining factor.MethodsThis was a retrospective cohort study that reviewed 80,714 electronic medical records of ED patients from December 1, 2012, to December 1, 2014. Univariate and multivariate analyses were carried out on raw data, and we used a complex regression analysis to develop a predictive model of ED LOS. Potential covariates were patient factors, temporal factors, clinical factors, and workload variables (volume and acuity of patients three hours prior to and two hours after presentation by a baseline patient). The analysis was performed using R studio 0.99.467.ResultsEthnicity dropped out in the stepwise regression procedure; after adjusting for other factors, a specific ethnicity effect was not informative. Maori were, on average, younger, less likely to receive bloodwork and radiographs, less likely to go to our observation area, less likely to have a general practitioner, and more likely to be discharged and to self-discharge; all of these factors decreased their length of stay.ConclusionLength of stay in our ED does not seem to be related to ethnicity alone. Patient factors had only a small impact on ED LOS, while clinical factors, temporal factors, and workload variables had much greater influence.
Highlights
Emergency department length of stay (ED LOS) is currently used in Australasia as a quality measure
Our study reinforces some previous findings about emergency department (ED)
A recent systematic review of ED LOS studies found that admission, older age, diagnostic testing, and moderate acuity were related to longer LOS.[10]
Summary
In our ED, Maori, the indigenous people of New Zealand, have a shorter ED LOS than European patients. This is despite Maori having poorer health outcomes overall. In 2009, one study found that black patients admitted to hospital (intensive care unit [ICU] and non-ICU) through the ED have longer ED length of stay (LOS) compared to nonblacks.[1] In 2013, another study found that pediatric nonHispanic black and Hispanic patients were less likely to receive any analgesic or narcotic analgesic, and were more likely to have a prolonged ED LOS than non-Hispanic white patients who presented with abdominal pain.[2] In an analysis of ED wait times for stroke patients in the U.S in 2011, black patients had longer wait times than Hispanic or white patients, with the suggestion that this led to treatment delays and sub-optimal stroke care.[3] Sonnenfeld, et al in 2012 found that nonHispanic black patients wait longer for ED care than whites,[4] while in Australia in 2009, Brown and Furyk found that
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
