Abstract
BackgroundEmergency department (ED) overcrowding is a potential threat for patient safety. We searched for independent determinants of prolonged ED length of stay (LOS) with the aim to identify factors which can be targeted to reduce ED LOS, which may help in preventing overcrowding.MethodsThis prospective cohort study included consecutive ED patients in a Dutch tertiary care centre. Multivariable logistic regression analysis was used to identify independent determinants of ED LOS > 4 h, including patient characteristics (demographics, referral type, acuity, (number of) presenting complaints and comorbidity), treating specialty, diagnostic testing, consultations, number of patients in the ED and disposition. Furthermore, we quantified the absolute time delays (measured in real-time) associated with the most important independent determinants of prolonged ED LOS.ResultsIn 1434 included patients independent determinants of prolonged ED LOS were number and type of presenting complaints, specialty, laboratory/radiology testing and consultations, and ICU admission. Modifiable determinants with the largest impact were blood testing; Adjusted odds ratio (AOR (95%-CI)); 3.45 (1.95–6.11), urine testing; 1.79 (1.21–2.63), radiology imaging; 3.02 (2.13–4.30), and consultation; 5.90 (4.08–8.54).Combined with the laboratory/radiology testing and/or consultations (requested in 1123 (78%) patients) the decision-making and discharge process consumed between 74 (42%) and 117 (66%) minutes of the total ED LOS of 177 (IQR: 129–225) minutes.ConclusionsIn tertiary care EDs, ED LOS can be reduced if the process of laboratory/radiology testing and consulting is optimized and the decision-making and discharge procedures are accelerated.
Highlights
Emergency department (ED) overcrowding is a potential threat for patient safety
A prolonged ED length of stay (LOS) keeps doctors and nurses longer occupied with one patient, and decreases the effective capacity which contributes to overcrowding
Despite the fact that numerous ED and patient characteristics have been associated with prolonged ED LOS, a recent systematic van der Veen et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2018) 26:81 review demonstrated that previous studies were inappropriate to decide which factors need to be targeted to optimize ED logistics [7]
Summary
Emergency department (ED) overcrowding is a potential threat for patient safety. Introduction A prolonged ED length of stay (LOS) keeps doctors and nurses longer occupied with one patient, and decreases the effective capacity which contributes to overcrowding. Emergency department (ED) overcrowding is associated with worse patient outcomes and satisfaction among health workers and patients [1,2,3]. Despite the fact that numerous ED and patient characteristics have been associated with prolonged ED LOS, a recent systematic van der Veen et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2018) 26:81 review demonstrated that previous studies were inappropriate to decide which factors need to be targeted to optimize ED logistics [7]. Comorbidity increases, in combination with multiple presenting complaints, the complexity of care and could contribute to a prolonged ED LOS. Patients of a tertiary care centre have more comorbidities and presenting complaints
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