Abstract
The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2–4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20–1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.
Highlights
Emergency department (ED) crowding is a term that is used to describe a phenomenon in the ED in which there is an imbalance between needs and access to proper care [1]
Patient data were excluded if there was no full documentation of all variables, if patients died upon arrival to the ED or if the patient had an ED LOS > 4000 min leaving 639,385 patients that were included in the present analyses
Patients’ age ≥ 80 had the longest ED length of stay (ED-LOS), 297 min, patients between 60 and 79 years had an ED-LOS of 266 min and patients between 18 and 59 years had an ED-LOS of 235 min
Summary
ED crowding has been related to treatment delays, medical errors, and increased patient morbidity and mortality [2, 3]. ED length of stay (ED-LOS) is a well-accepted ED performance indicator and is closely related to crowding, quality of care and patient outcome [5]. Several studies, including trauma and non-trauma patients as well as patients with high and low clinical priority, have shown an association between increased ED-LOS and unfavourable outcomes such as increased mortality and in-hospital length of stay [6, 7]. The main aim of ED triage is not to predict short-term mortality but to early identify patients with high acuity. High acuity patients will be seen first, and triage priority is closely associated with ED-LOS. The patient’s presenting symptoms as well as the presence of senior or junior doctors may affect ED-LOS [8, 9]
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