Abstract
BackgroundThe Netherlands has a well-developed primary care system, which increasingly collaborates with hospital emergency departments (EDs). In this setting, insight into crowding in EDs is limited. This study explored links between patients’ ED Length of Stay (LOS) and their care pathways.MethodsObservational multicenter study of 7000 ED patient records from 1 February 2013. Seven EDs spread over the Netherlands, representing overall Dutch EDs, were included. This included three EDs with and four EDs without an integrated primary-care-physician (PCP) cooperative, forming one Emergency Care Access Point (ECAP). The main outcome was LOS of patients comparing different care pathways (origin and destination of ED attenders).ResultsThe median LOS of ED attenders was 130.0 min (IQR 79.0–140.0), which increased with patients’ age. Random coefficient regression analysis showed that LOS for patients referred by medical professionals was 32.9 min longer compared to self-referred patients (95 % CI 27.7–38.2 min). LOS for patients admitted to hospital was 41.2 min longer compared to patients followed-up at the outpatient clinic (95 % CI 35.3–46.6 min), 49.9 min longer compared to patients followed-up at the PCP (95 % CI 41.5–58.3 min) and 44.6 min longer compared to patients who did not receive follow-up (95 % CI 38.3–51.0 min). There was no difference in LOS between hospitals with or without an ECAP.ConclusionsWith 130 min, the median LOS in Dutch EDs is relatively short, comparing to other Western countries, which ranges from 176 to 480 min. Although integration of EDs with out-of-hours primary care was not related to LOS, the strong primary care system probably contributed to the overall short LOS of ED patients in the Netherlands.
Highlights
The Netherlands has a well-developed primary care system, which increasingly collaborates with hospital emergency departments (EDs)
In a separate regression model we explored the links of Length of Stay (LOS) with time of presentation, origin, follow up and the presence of an Emergency Care Access Point (ECAP) both separately and combined with age, sex and a trauma related problem
These were spread over the country, varied in size, and included the two largest EDs of the Netherlands
Summary
The Netherlands has a well-developed primary care system, which increasingly collaborates with hospital emergency departments (EDs). In this setting, insight into crowding in EDs is limited. Crowding of Emergency Departments (EDs) is a growing concern in many countries, leading to increasing lengths of stay (LOS) in the ED. There is an increasing trend towards implementing Emergency Care Access Point’s (ECAP); a place where EDs and PCPs work together, creating one desk where triage decides if the patient will be seen by a PCP or in the ED [13]. Despite growing concerns of increasing LOS in the Netherlands, there was a shortage of data on LOS at EDs and associated factors. There was no research available that looked at patients’ care pathways, that is origin and destination of patients attending the ED
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