Abstract
ObjectivesOne goal of Emergency Department (ED) operations is achieving an overall length of stay (LOS) that is less than four hours. The goal of the current study was to assess for association between increasing number of on-duty EM Consultants and LOS, while adjusting for overall (all-grade) on-duty emergency doctors’ numbers and other operational factors.MethodsThis was a retrospective analysis of three years (2016–2019) of data, employing a unit of analysis of 3276 eight-hour ED shifts. The study was conducted using a prospectively populated ED database in a busy (annual census 420,000) Middle Eastern ED with staffing by Consultants and multiple non-Consultant grades (Specialists, fellows, and residents). Using logistic regression, the main predictor variable of “on-duty Consultant n” was assessed for association with the study’s primary (dichotomous) endpoint: whether a shift’s median LOS met the target of < 240 min. Linear regression was used to assess for association between on-duty Consultant n and the study’s secondary (continuous) endpoint: median LOS for the ED shift.ResultsMultivariate logistic regression adjusting for a number of operations factors (including total EP on-duty complement) identified an association between increasing n of on-duty Consultants and the likelihood of a shift’s meeting the 4-h ED LOS target (OR 1.27, 95% CI 1.20 to 1.34, p < .0001). Multiple linear regression, which also adjusted for total on-duty EP n and other operational factors, also indicated LOS benefit from more on-duty Consultants: each additional on-duty Consultant was associated with a shift’s median LOS improving by 5.4 min (95% CI 4.3 to 6.5, p < .0001).ConclusionsAt the study site, in models that adjusted for overall on-duty EP numbers as well as myriad other operational factors, increasing numbers of on-duty Consultants was associated with a statistically and operationally significant reduction in ED LOS.
Highlights
What is already known on this subject? Placemteent of senior doctors at Emergency Department (ED) triage, found significant length of stay (LOS) benefits from the practice
Studies focusing on the effect of EM consultant in ED on the tMD, LOS, or adverse event rates present conflicting conclusions
The current study potentially adds to these reports in that we examined primary endpoint as shift median LOS meeting the 4-h target in a very high-volume ED
Summary
The LOS is defined as elapsed time from patient presentation to the time of ED departure (whether for admission or discharge). The LOS is important because of its obvious relationship to efficiency and overcrowding, and being linked to care quality and patient satisfaction [1,2,3]. The waiting time to see a physician (time to physician, tMD) should be minimized in order to expedite time-critical care, reduce overall LOS, and reduce rates of patients leaving without being seen (LWBS) [9, 10]. Assessments of LOS and its components (e.g. tMD, time from discharge order to ED departure) have stressed operational and medical benefits from throughput improvements [1, 11,12,13].
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