Abstract
Study ObjectiveWe compared the effects of execution of diagnostic tests in the emergency department (ED) and other common factors on the length of ED stay to identify those with the greatest impacts on ED crowding.MethodsBetween February 2010 and January 2012, we conducted a cross-sectional, single-center study in the ED of a large, urban, teaching hospital in Japan. Patients who visited the ED during the study period were enrolled. We excluded (1) patients scheduled for admission or pharmaceutical prescription, and (2) neonates requiring intensive care transferred from other hospitals. Multivariate linear regression was performed on log-transformed length of ED stay in admitted and discharged patients to compare influence of diagnostic tests and other common predictors. To quantify the range of change in length of ED stay given a unit change of the predictor, a generalized linear model was used for each group.ResultsDuring the study period, 55,285 patients were enrolled. In discharged patients, laboratory blood tests had the highest standardized β coefficient (0.44) among common predictors, and increased length of ED stay by 72.5 minutes (95% CI, 72.8–76.1 minutes). In admitted patients, computed tomography (CT) had the highest standardized β coefficient (0.17), and increased length of ED stay by 32.7 minutes (95% CI, 40.0–49.9 minutes). Although other common input and output factors were significant contributors, they had smaller standardized β coefficients in both groups.ConclusionsExecution of laboratory blood tests and CT had a stronger influence on length of ED stay than other common input and output factors.
Highlights
Emergency department (ED) crowding represents a serious problem in emergency medicine
The median length of ED stay for all patients was 91 minutes (IQR, 54–154 minutes)
In this analysis of input, output, and throughput factors contributing to length of ED stay, laboratory blood testing had the strongest influence on length of ED stay in discharged patients, increasing it by 74.5 minutes compared to those discharged patients who did not have blood tests
Summary
[1] Further, ED crowding does cause this ambulance diversion, and delays treatment in the ED, which adversely affects patient outcomes. Diagnostic tests in ED were recognized as one of major contributors to ED crowding. [4] other contributors to ED crowding have been identified. Entry overload contributed to ED crowding in Australia. [6] patient age is an independent contributor to ED crowding, with older patients staying longer than young patients. [7] The glut of factors contributing to ED crowding has precluded an effective prioritization of interventions to reduce the problem. To establish effective interventions, identifying contributing factors and understanding the extent of their contributions to ED crowding is necessary
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