Abstract
Study objectiveTo assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).MethodsA retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of internal medicine patients <65 years old were included. Organisational factors were defined as non-medical factors. ED-LOS is defined as the time between ED arrival and ED discharge or admission. Prolonged ED-LOS is defined as ≥75th percentile of ED-LOS in the study population, which was 208 minutes.ResultsData on 1782 emergency department visits by elderly patients and 597 emergency department visits by younger patients were analysed. Prolonged ED-LOS in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3–4.3), a higher number of diagnostic tests (OR 1.2, 95% CI 1.16–1.33) and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0–8.8 and OR 2.3, 95% CI 1.4–3.9). In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4–4.6). Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.ConclusionOrganisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.
Highlights
The Emergency Department (ED) manages complex patient populations and is under continuous time pressure [1,2]
Prolonged emergency department length of stay (ED-LOS) in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3–4.3), a higher number of diagnostic tests and evaluation by a medical student or PLOS ONE | DOI:10.1371/journal.pone
Organisational Factors Induce Prolonged ED-LOS in Elderly Patients non-trainee resident compared with a medical specialist
Summary
ED crowding leads to prolonged emergency department length of stay (ED-LOS), delay in treatment and a worse medical outcome, such as a longer hospital stay and a higher mortality rate [3,5,8,10,11,12]. Prolonged ED-LOS reduces patient satisfaction and has a negative impact on the quality of care and the adherence to ED guidelines [3,13]. The association of prolonged ED-LOS with poor patient outcome has been studied in various settings and patient groups, demonstrating diverse results [19,20,21,22]. ED-LOS has been reported to exceed 4 hours in 26% of elderly patients and in 11% of patients aged 18–64 years [23]. A large prospective study showed no association between prolonged ED-LOS and age [24]
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