Emergency Department Length Of Stay Research Articles

Prolonged length of stay and associated factors among emergency department patients in Ethiopia: systematic review and meta-analysis.

The duration between a patient's arrival at the Emergency Department (ED) and their actual departure, known as the Emergency Department Length of Stay (EDLOS), can have significant implications for a patient's health. In Ethiopia, various studies have investigated EDLOS, but a comprehensive nationwide pooled prevalence of prolonged EDLOS, which varies across different locations, is currently lacking. Therefore, the objective of this systematic review and meta-analysis is to provide nationally representative pooled prevalence of prolonged EDLOS and identify associated factors. In this study, we conducted a comprehensive systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. We conducted a thorough search of numerous international databases, including PubMed/Medline, SCOPUS, Web of Science, and Google Scholar. The primary outcome was the prevalence of prolonged EDLOS. The secondary outcome was factors affecting the EDLOS. Random-effects model was used to since there was high heterogeneity. We also conducted subgroup analysis and meta-regression to investigate heterogeneity within the included studies. To assess publication bias, we used Egger's regression test and funnel plots. All statistical analyses were performed using STATA version 17.0 software to ensure accurate and reliable findings. We have identified eight articles that met our inclusion criteria with a total sample size of 8,612 participants. The findings of this systematic review and meta-analysis indicate that the pooled estimate for the prevalence of prolonged EDLOS is 63.67% (95% CI = 45.18, 82.16, I2 = 99.56%, P = 0.0001). The study identified several significant factors associated with prolonged EDLOS, including patients admitted to overcrowded emergency departments (OR = 5.25, 95% CI = 1.77, 15.58), delays in receiving laboratory findings (OR = 3.12, 95% CI = 2.16, 4.49), and delays in receiving radiological results (OR = 3.00, 95% CI = 2.16, 4.16). In this review, the EDLOS was found to be very high. Overcrowding, delays in laboratory test findings, and delays in radiology test results make up the factors that have a statistically significant association with prolonged EDLOS. Given the high prevalence of prolonged EDLOS in this review, stakeholders should work to increase the timeliness of ED services in Ethiopia by proper disposition of non-emergency palliative patients to the appropriate destination, and implementing point-of-care testing and imaging.

Self-Efficacy of Nurses and Physicians in the Emergency Department and Its Influence on the Outcomes of Trauma Patients

The purpose of this study was to examine the effect of self-efficacy on the implementation of the adult trauma clinical practice guidelines (ATCPGs) on improving trauma patient outcomes, including missed injuries, and ED LOS. Nurses’ and physicians’ self-efficacy in performing ATCPGs skills were evaluated three months prior to and three months after the intervention’s implementation. Multiple strategies of ATCPGs implementation improved the length of stay (LOS) in the ED for multiple trauma patients. The quasi-experimental design has been implemented in this interventional study. Post-intervention, the self-efficacy of ED healthcare providers in performing ATCPGs skills has increased. Implementation of the ATCPGs has improved the outcomes of patients with multiple traumas. There were 66 patients in this study, and 53 (80.3%) of them were male. The ATCPGs intervention resulted in a statistically significant decrease in the amount of time spent in the ED, as shown by a comparison of the ED LOS in minutes between the two groups (t = 2.56; p = 0.013). Implementing the ATCPGs has improved multiple trauma patients’ outcomes. The results will help decision-makers at hospitals to facilitate interdisciplinary ATCPGs training sessions and establish policies and procedures to introduce adult trauma sheet in the ED to improve multiple trauma patients’ outcomes.

The mobile seniors’ clinic - an innovative transition of care for frail older adults

BackgroundThis study aims to evaluate the impact of Quebec’s first hospital-at-home-inspired mobile Seniors’ Clinic, the “Clinique des Ainés (CDA)”, on frail older adults’ returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations.MethodsDesign: Quasi-experimental pre-post implementation cohort study. Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention). Outcomes: return to ED (RtoED), mortality, ED & hospital LOS, and rehospitalizations. Statistical analyses: Multivariable regression modelling.ResultsOverall, 891 patients were included. At the intervention site (CDA) (n = 437), RtoED were similar at 30 (17.5% & 19.5%, p = 0.58), 90 (34.4% & 37.3%, p = 0.46) and 180 days (47.2% & 54.0%, p = 0.07) in the pre and post-implementation phases. No mortality differences were found. The hospitalization LOS was significantly shorter (28.26 and 14.22 days, p < 0.01). At 90 days, rehospitalization LOS was decreased by 8.51 days (p = 0.02) and by 6.48 days at 180 days (p = 0.03). Compared to the control site (n = 454) in the post-implementation phase, RtoED was 54% at the intervention site compared to 44.1% (p = 0.02) at 180 days. The CDA had a lower adjusted probability of mortality at 90 days compared to the control site (4.8% VS 11.7%, p = 0.03). No rehospitalization LOS differences were noted.ConclusionsThe Clinique des Ainés showed effectiveness in caring for frail older patients in their homes by decreasing their hospital LOS by half and 90 days mortality risk. It was a safe care trajectory without a clinically significant increase in ED returns or mortality.

Variation in batch ordering of imaging tests in the emergency department and the impact on care delivery.

To examine heterogeneity in physician batch ordering practices and measure the associations between a physician's tendency to batch order imaging tests on patient outcomes and resource utilization. In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates. The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters. Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order. This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.

The impact of reduced pediatric emergency care hours on the patterns of emergency department utilization

Purpose: The declining recruitment rate of pediatric residents in Korea has led to a decrease in the number of emergency departments (EDs) offering a 24/7 pediatric emergency care (PEC). This study evaluated the impact of reduced PEC hours on the utilization patterns of a single ED.Methods: We reviewed medical records of pediatric patients who were defined as individuals aged 14 years or younger undergoing pediatricians’ practices in a tertiary hospital ED in Korea. Given the reduction of PEC hours from full-time to 08:00-24:00 on September 27, 2022, the patients were grouped as those who visited during March 27, 2022-September 26, 2022 (“control”), and those who visited during September 27, 2022-March 26, 2023 (“reduction”). The following variables were analyzed between the 2 periods: the number of patients, age, sex, visits via ambulances, severity by the Korean Triage and Acuity Scale with high acuity (a level 1-2 of the scale), disease-related visits, time of visit, ED length of stay (EDLOS), disposition, chief complaints, and diagnoses.Results: Among 3,577 pediatric patients, 1,315 visited the ED during the reduction period, down by 41.9% in numbers from the control period. From the control to reduction periods, we observed an increase in the median age (from 3.0 years [interquartile range, 1.0-7.0] to 4.0 years [1.0-8.0]; P = 0.005) and decreases in the median EDLOS (from 140.0 minutes [80.0-217.0] to 104.0 minutes [54.0-169.8]; P &lt; 0.001) and proportion of hospitalization (from 22.1% to 12.6%; P &lt; 0.001). No change was observed in the proportions of highacuity cases or chief complaints. We noted decreases in infection-related diagnoses during the reduction.Conclusion: Reducing PEC hours was associated with shorter EDLOS, fewer hospitalizations, and older age, with no difference in the severity. Even with reduced PEC hours, relevant resources should be redistributed to ensure the accessibility to PEC.

The use and impact of pathology tests in emergency department patients with mental health-related complaints: A cross sectional study.

To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management. In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management. Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management. Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.

Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers

Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers. Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition. Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P &amp;lt; 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P &amp;lt; 0.001), discharged home (286 vs 160 min, P &amp;lt; 0.001), non-ICU admissions (234 vs 164 min, P &amp;lt; 0.001), and those requiring surgery (126 vs 101 min, P &amp;lt; 0.001). Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

Effectiveness of accelerated diagnostic protocols for reducing emergency department length of stay in patients presenting with chest pain: A systematic review and meta-analysis.

In recent years, there has been an increase in the use of accelerated diagnostic protocols (ADPs) and high-sensitivity troponin assays (hsTn) for the assessment of chest pain in emergency departments (EDs). This study aimed to quantitatively summarize the operational and clinical outcomes of ADPs implemented for patients with suspected cardiac chest pain. To be considered eligible for inclusion, studies must have implemented some form of ADP within the ED for evaluating adult (age ≥18 years) patients presenting with chest pain using Tn assays. The primary outcome was ED length of stay (LOS). Secondary outcomes included the proportion of patients admitted and the proportion with 30-day major adverse cardiac events (MACE). Thirty-seven articles involving 404,566 patients met the inclusion criteria, including five randomized controlled trials (RCTs) and 32 observational studies. A significant reduction in total ED LOS was reported in 22 observational studies and four RCTs. Emergency departments with longer baseline ED LOS showed significantly larger reductions in LOS after ADP implementation. This observed association persisted after adjusting for both the change in serial Tn measurement interval and transition from conventional Tn assay to an hsTn assay (β = -0.26; 95% CI, -0.43 to -0.10). Three studies reported an increase in the proportion of patients admitted after introducing an ADP, one of which was significant while 15 studies reported a significant decrease in admission proportion. There was moderate heterogeneity among the 13 studies that reported MACE proportions, with a non-significant pooled risk ratio of 0.95 (95% CI, 0.86-1.04). Implementation of ADPs for chest pain presentations decreases ED LOS, most noticeably within sites with a high baseline LOS; this decreased LOS is seen even in the absence of any change in troponin assay type. The decrease in LOS occurred alongside reductions in hospital admissions, while not increasing MACE. The observed benefits translated across multiple countries and health regions.

Optimizing Emergency Department Length of Stay and Quality of Care: A Quality Improvement Project.

Background Patients' long length of stay (LOS) in the emergency department (ED) is a common measure of quality of care that could be a cause of increased morbidity and mortality. This quality improvement project (QIP) aimed to identify causes of long LOS and to improve common causes such as long consultation times. Methodology Over two months, three plan, do, study, and act (PDSA) cycles were conducted aiming to identify causes of long ED LOS and improve common causes that extended ED LOS beyond four hours. Additionally, the projectaimed to reduce the time taken from requesting a consultation from another specialty until it was completed and documented to an average of 60 minutes. Main interventions included raising awareness of staff and administration through video presentations, printed posters, direct contact, and optimizing the electronic health records system to audit performance. Results From PDSA cycle 1 through PDSA cycle 3, average consultation times decreased from 91 to 65 minutes. Common organization-related causes of long LOS included pending radiology or laboratory investigations, awaiting inpatient admission, and awaiting consultations from other specialties. Physician-related factors included delay in documentation likely resulting from heavy workload. Pending investigations and admissions were factors that could be amended with better administrative control. Conclusions A multifaceted approach that tackles physician-related and organization-related factors could be a necessity to improve LOS and the quality of care in the ED. Having staff and administration aware of targets and performance along with utilizing the electronic health records system to audit performance and increase efficiency are beneficial in improving the LOS in the ED.

Effectiveness of a Disability Liaison Officer service in a metropolitan emergency department.

To identify the influence of a Disability Liaison Officer (DLO) service in the ED setting on people with disability (PWD). For this project, PWD included adults with communication disability, intellectual disability or autism spectrum disorder. This was a single-centre retrospective cohort study, at an adult major referral ED in Melbourne, Australia. Patients were eligible for inclusion if they were ≥18 years of age, presented to the ED between 1 April 2022 and 30 April 2023, and had a disability alert in their electronic medical record. Eligible patients were divided into two cohorts: (i) patients managed using standard ED care and (ii) patients managed using DLO model. ED length of stay (LOS) was the main outcome measure. After adjusting for baseline differences in age, initial GCS and disability type, the DLO service was associated with earlier disposition from the ED (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI]: 1.23-1.69; P < 0.001). For the subgroup of patients discharged directly from the ED, the association of DLO service and earlier disposition remained statistically significant (aHR 2.47; 95% CI: 1.83-3.33; P < 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99-2.80; P = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65-1.23; P = 0.50), there was no significant association of the DLO service with time to disposition. The DLO service was associated with a reduction in ED LOS for PWD. Further assessment of the service using patient- and carer-reported outcome measures and cost-effectiveness studies are indicated.

Predictive Factors of Emergency Department Length of Stay: Analyzing National Emergency Department Data.

This study aimed to identify and analyze the factors influencing Emergency Department Length of Stay (ED LOS) using a nationwide database to improve emergency care efficiency. This retrospective study utilized data from the National Emergency Department Information System (NEDIS) in South Korea, covering 25,578,263 ED visits from 2018 to 2022. Patient demographics, clinical characteristics, and ED operational variables were examined. The study employed univariate and multivariate logistic regression analyses to assess the association between these factors and prolonged ED LOS, defined as six hours or more. Among the 25,578,263 patients included, median ED LOS was 2.1 hours (interquartile range [IQR], 1.050 - 3.830 hours), with 12.6% experienced a prolonged ED LOS. Elderly patients (aged ≥ 65 years) were significantly more likely to experience prolonged ED LOS (adjusted odds ratio [aOR]: 1.415, 95% confidence interval [CI]: 1.411-1.419). Patients transferred from other hospitals (aOR: 1.469, 95% CI: 1.463-1.474) and those arriving by 119 ambulances (aOR: 1.093, 95% CI: 1.077-1.108) also had higher odds of prolonged LOS. Conversely, pediatric patients had a lower likelihood of extended stays (aOR: 0.682, 95% CI: 0.678-0.686). Severe illness, including sepsis (aOR: 1.324, 95% CI: 1.311-1.340) and COVID-19 infection (aOR: 1.413, 95% CI: 1.399-1.427), were strongly associated with prolonged LOS. Prolonged ED LOS is influenced by a combination of patient demographics, clinical severity, and systemic factors. Targeted interventions focusing on older adults, severe illness, and operational inefficiencies, such as hospital transfers, are essential for reducing ED LOS and improving overall emergency care delivery.

Implementation of an early attention strategy to reduce emergency room overcrowding in an academic institution in Colombia, a pilot study

Overcrowding is a worldwide problem, and long waiting times are associated with increased morbidity and even mortality of patients regardless of triage classification. Although there are many tools published in the literature that contribute to the reduction of overcrowding, for the Colombian population there are not many tools evaluated to reduce the length of stay of patients in the emergency department. This is a retrospective analytical study that compared whether there was a difference in patient definition time and ED length of stay between a group attended under an early care protocol (PAT) versus the usual protocol. Of the total of 969 patients included it was found that the group attended under the PAT protocol had a shorter definition time than the usual protocol, also the Emergency department length of stay (EDLOS) was significantly lower in the PAT group compared to the usual protocol. The implementation of the PAT protocol performed by emergency physicians allows a faster contact with the patient by the physician, and leads to a significant reduction of EDLOS, contributing to the reduction of overcrowding in the emergency department.

Mapping the patient journey: utilizing clinical informatics for a conceptual approach to identify aspects of emergency department access block

BackgroundThe study aims to map the patient journey in a regional Emergency Department (ED), identify factors causing extended Length of Stay (LOS) in ED during pre-COVID (2016–2019), COVID (2020–2022) and post-COVID (2023), and analyse the patient journey using clinical informatics. Through systematic analysis and root cause identification, the study seeks to establish a learning health system. This system will enhance patient experiences and improve timely and effective care delivery.MethodsSummarized data on ED presentations data were sourced from January 2016 to August 2023 for a 294-bed regional hospital in New South Wales (NSW). The patient’s journey from ED to admission inpatient wards was analysed using clinical informatics. The time spent in each segment of the ED journey was analysed separately and subdivided by specialty for further analysis.ResultsPatient characteristics remained similar year on year. The average ED LOS increased from 5.59 h during the pre-COVID period (2016–2019) to 8.48 h during the COVID period (2020–2022) and 8.52 h during the post-COVID period (2023). The hospital’s bed occupancy rate remained consistent before and during the COVID-19 pandemic, with a slight improvement afterwards, except for a decrease in 2020. The occupancy rate for ED-accessible beds during the pre-COVID period is higher than during the COVID and post-COVID periods. The admission from ED to Inpatient wards decreased from 35% pre-COVID to 28% during COVID. Of the total LOS, the ‘Bed Request’ to ‘Bed Ready’ time segment increased from 11.41% in 2016 to 41.19% in 2022. The admission of medical specialty consistently made up most admissions (32%) which increased during the COVID. The medical specialty also spent the most time in the ED, peaking at 880 min in 2022.ConclusionClinical Informatics is an effective tool to visualise the bottlenecks in clinical workflows. The ‘Bed Request’ to ‘Bed Ready’ time segment was the largest contributor to ED LOS and may have been attributed to a lack of bed availability. Patients took an average of 50 min to be transferred to Inpatient wards upon admission. Future studies could utilize insights gained to develop specific key performance indicators aimed at improving ED LOS. Moreover, we are currently working on improving real-time access to inpatient beds but are currently hampered by the ‘manual update’ of bed status that is controlled by the individual wards. We aim to build an automated system that can monitor and update bed availability (e.g., patient discharge) with minimal human intervention.

358 Reduction in Emergency Department Length of Stay and Head CT Utilization With Implementation of Brainscope in Head Injury Evaluation

358 Reduction in Emergency Department Length of Stay and Head CT Utilization With Implementation of Brainscope in Head Injury Evaluation

202 Navigating the ‘Twindemic’: A Predictive Model for Emergency Department Length of Stay in COVID-19 and Influenza Patients

202 Navigating the ‘Twindemic’: A Predictive Model for Emergency Department Length of Stay in COVID-19 and Influenza Patients

Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study

BackgroundForearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block...

Emergency department discharges directly to hospice: Longitudinal assessment of a streamlined referral program

Introduction80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice. MethodsWe implemented a QI program in September 2021 consisting of three components: (1) clarification and streamlining of referral workflows, (2) staff/provider education on hospice and workflows, and (3) electronic medical record (EMR) tools to facilitate hospice transitions. The primary outcome was the change in monthly ED-to-hospice cases pre- and post-implementation. We also calculated the monthly incidence rate of ED-to-hospice transfers. The secondary outcome was ED length of stay (LOS). Results202 patients completed ED-to-hospice transfers from January 1, 2019 to February 29, 2024. 98 patients transitioned from the ED to hospice before QI implementation, and 104 patients transitioned after implementation. We observed a slight but insignificant increase in the mean monthly ED-to-hospice cases from 3.16 patients per month pre-implementation to 3.47 patients per month post-implementation (P = 0.46). We found no significant difference in the monthly incidence rate of ED-to-hospice cases before and after implementation (P = 0.78). ED LOS was unaffected (P = 0.21). ConclusionIn this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.

Measuring Overcrowding in a Large Academic Tertiary Care Pediatric Emergency Department.

Overcrowding scores have been studied extensively in adult emergency departments (EDs), but few studies have determined utility in the pediatric setting. The objective of this study was to determine the association between a modified National Emergency Department Overcrowding Score (mNEDOCS) and established ED metrics in a large academic tertiary care pediatric ED. NEDOCS was modified to increase applicability in the pediatric setting by including the number of patients in resuscitation rooms instead of a number of patients on ventilators. Patient characteristics, ED disposition, ED length of stay (LOS), rate of left without being seen (LWBS), hospital LOS (HLOS), ED returns within 72 hours, and mNEDOCS were acquired retrospectively for every ED encounter in 2016-2019 using the electronic health record. Descriptive statistics, Spearman correlation, and multivariate analyses were calculated to evaluate the association between specific ED metrics and mNEDOCS. Modified NEDOCS positively correlated with ED LOS, LWBS, and rate of 72-hour return visits. A negative correlation was found between mNEDOCS and HLOS. When controlling for select covariates, the odds of LWBS doubled with each increase in mNEDOCS category (odds ratio, 2.03; 95% confidence interval [CI], 2.00-2.06), ED LOS was associated with an increase of 27 minutes as mNEDOCS category increased (β = 26.80; 95% CI, 26.44-27.16), and the odds of 72-hour return visits increased by 6% when mNEDOCS increased by one category (odds ratio, 1.06; 95% CI, 1.05-1.07). Hospital LOS was associated with a 100-minute decrease per increase in mNEDOCS category (β = -99.85; 95% CI, -180.68 to -18.48) when controlling for covariates. Modified NEDOCS is positively associated with ED LOS, LWBS, and 72-hour return visits, consistent with adult data. Further investigation is needed to elucidate the association between mNEDOCS and HLOS. This study illustrates the utility of mNEDOCS as a measure of overcrowding in a pediatric ED.

The role of emergency department crowding on the implementation of efficiency strategies to improve care for adult patients presenting with chest pain.

IntroductionThis study evaluated the operational and clinical outcomes for patients presenting to an emergency department (ED) with chest pain using a 2-hour high-sensitivity troponin T (hs-TnT) protocol compared to an existing 3-hour hs-TnI protocol. MethodsThis retrospective cohort study used eight population-based linked health administrative datasets for adult patients presenting to a Canadian urban ED with chest pain over a two-year period. The primary outcome was ED length of stay (LOS). Secondary outcomes included health outcomes within 30 days. ResultsOverall, 5426 patients were included; 2879 and 2547 in the hs-TnI group and hs-TnT groups, respectively. The cohorts were similar: the median age was 58 years, 55% male, and comorbidities matched. Delays in physician initial assessment (PIA; +54 min; 95% CI: 42.2-65.8) and patients leaving without being seen increased (7% vs 12.5%; P &lt; 0.0001) due to worsening overcrowding. The median ED LOS increased from 448 to 481 minutes after hs-TnT implementation (median difference = 33.0; 95% CI: 19.9 to 46.1), although time to second tests decreased by 54 minutes. At 30 days, there were no differences in readmission or death before and after the intervention. ConclusionImplementation of a 2-hour hs-TnT protocol resulted in mixed outcomes: increased PIA and ED LOS, yet faster time to second test. The journey through the ED for patients with chest pain is complex and affected by issues beyond the assay type and the timing of repeat Tn measurements. ED overcrowding needs to be addressed for efficiency to be realized in this setting.

Retrospective Cohort Analysis of the Relationship Between Emergency Department Length of Stay and Timing of First Laboratory Orders.

Background The efficiency of patient management in the Emergency Department (ED) is critical for optimizing healthcare delivery.Provider in triage (PIT) and similar ED flow models attempt to expedite throughput by decreasing the amount of time between patient arrival and initial order placement.The exact relationship between ED length of stay (LOS) and the timing of the first laboratory order, however, is unclear.The varying speed at which clinicians of different ages place laboratory orders and move patients through an ED also is understudied. Methods A retrospective analysis was conducted using SQL from the Clarity data archive to pull all patient encounters in 2023. Linear regression models using Analysis ToolPak in Microsoft Excel were used to create and examine the relationship between LOS and the timing of the first laboratory order. Secondary outcomes using the same models were created to analyzethe impact of clinician age on LOS and the relationship between clinician age and the timing of first laboratory orders. Results Two hundred sixty-nine thousand eight hundred and eight ED visits were reviewed across three academic and 17 community emergency departments. We report a weak but statistically significant positive relationship between the timing of the first laboratory order and LOS (R² = 0.0378, p < 0.001). Secondary outcomes indicated a very weak negative correlation between clinician age and LOS (R² ≈ 0, p < 0.001) and no significant relationship between clinician age and the timing of the first laboratory order (R² ≈ 0, p > 0.05). Conclusion The timing of the first laboratory order is a significant, albeit weak, predictor of LOS in the ED. Clinician age has minimal impact on LOS and does not significantly influence the timing of the first laboratory order.