Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

Felix Greiner,Ronny Otto,Wiebke Schirrmeister,Felix Walcher,Susanne Drynda,Sabine Blaschke

doi:10.1007/s11739-021-02919-1

Felix Greiner, Ronny Otto + Show 4 more

Open Access

https://doi.org/10.1007/s11739-021-02919-1

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Abstract

Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

Highlights

Complexity of emergency treatment as well as the decision of priority have a substantial impact on emergency department (ED) processes [1, 2]
V.), defines items such as the demographic data, Canadian Emergency Department Information System (CEDIS) Presenting Complaint List [26], acuity assessment according to the Manchester Triage System (MTS), and the Emergency Severity Index (ESI) as well as vital parameters, date/time, and diagnoses coded by the German modification of the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10-GM) at the end of the ED treatment [27]
Twelve AKTIN EDs participated in the study, which included four extended emergency care providers (EECP), seven comprehensive emergency care providers (CECP), and one basic emergency care provider (BECP)

Summary

Introduction

The process within the ED usually starts with the admission of the emergency patient, followed by acuity assessment (triage), diagnosis, treatment initiation, and decisions on discharge or further inpatient treatment [3]. The periods between these procedures are defined as process times. They play an important role in the evaluation of the quality of care in EDs and are influenced. Overcrowding is one of the most common problems observed in EDs and is mainly caused by an excessively long LOS within the ED, leading to a disruption of all processes and a dramatic increase in risks of emergency treatment [14,15,16]. It is important to evaluate all factors influencing the

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