Abstract
This study was to determine whether prolonged emergency department (ED) length of stay (LOS) is associated with increased risk of in-hospital cardiac arrest (IHCA). A retrospective cohort with a nationwide database of all adult patients who visited the EDs in South Korea between January 2016 and December 2017 was performed. A total of 18,217,034 patients visited an ED during the study period. The median ED LOS was 2.5 h. IHCA occurred in 9,180 patients (0.2%). IHCA was associated with longer ED LOS (4.2 vs. 2.5 h), and higher rates of intensive care unit (ICU) admission (58.6% vs. 4.7%) and in-hospital mortality (35.7% vs. 1.5%). The ED LOS correlated positively with the development of IHCA (Spearman ρ = 0.91; p < 0.01) and was an independent risk factor for IHCA (odds ratio (OR) 1.10; 95% confidence interval (CI), 1.10–1.10). The development of IHCA increased in a stepwise fashion across increasing quartiles of ED LOS, with ORs for the second, third, and fourth relative to the first being 3.35 (95% CI, 3.26–3.44), 3.974 (95% CI, 3.89–4.06), and 4.97 (95% CI, 4.89–5.05), respectively. ED LOS should be reduced to prevent adverse events in patients visiting the ED.
Highlights
In-hospital cardiac arrest (IHCA) is an acute episode that can occur in hospitalized patients during an emergency department (ED) stay or after admission [1]
Emergency physicians and nurses are rarely educated in care of critically ill patients, and patient-to-nurse ratios are quite higher in the ED than in the intensive care unit (ICU) which may lead to poor medical services [5]
ED length of stay (LOS) was longer in patients who did than did not experience in-hospital cardiac arrest (IHCA) (4.2 vs. 2.5 h)
Summary
In-hospital cardiac arrest (IHCA) is an acute episode that can occur in hospitalized patients during an emergency department (ED) stay or after admission [1]. Caring for critically ill patients is challenging, and requires delicate monitoring and interventions. Because ED care focuses more on prompt diagnosis and stabilization than on detail care of the patient, as in the intensive care unit (ICU) or admission as an inpatient, a more extended stay in the ED could increase the risk of adverse events [5]. Emergency physicians and nurses are rarely educated in care of critically ill patients, and patient-to-nurse ratios are quite higher in the ED than in the intensive care unit (ICU) which may lead to poor medical services [5]
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