Emergency Department Wait Times in NYS Hospitals on Prevalence of Hospital-Acquired C. difficile Infection

Abstract

<h3>Background</h3> C. difficile is the most common hospital-acquired infection, as it is resistant to many sterilization and disinfection measures and can persist in the environment for extended periods of time. Given the fast-paced, high-volume care environment of emergency departments (ED), higher levels of C. difficile contamination are often found in the ED, compared to other areas of the hospital. This study examined the relationship between average patient wait times in the ED before admission, and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals. <h3>Methods</h3> A time series (2013-2015), fixed-effects regression analysis was conducted comparing each facility's annual average ED wait time for admitted patients, to that facility's average (HA-CDI) rates, limited to patients entering through the ED. This model controlled for known clinical and non-clinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age. <h3>Results</h3> ED wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional .003 cases of HA-CDI/1,000 patient discharges with every additional minute patients spend in that facility's emergency department (P < .001), on average. Standardized coefficients were also calculated to indicate variable effect size in the model. ED wait times had the largest effect size (.310), indicating they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI. <h3>Conclusions</h3> The relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients, or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.