Hospital Delay Research Articles

PRE HOSPITAL AND IN HOSPITAL DELAYS AFTER THE ONSET OF ACUTE ISCHEMIC STROKE IN A SAMPLE OF EGYPTIAN PATIENTS

Background: Cerebrovascular stroke (CVS) is the second most common cause of death after ischemic heart disease and the third most common cause of disability after ischemic heart disease and cancer. Objective: Investigating the time lags and the factors causing pre hospital and in hospital delays after acute ischemic stroke. Patients and Methods: This study included 70 patients recruited from the Neurology Department Al -Azhar University (Al Hussein Hospital) and El Sahel Teaching Hospital during the period from November 2018 to June 2019 with the diagnosis of acute ischemic stroke. Results: The pre hospital time ranged from 6 to168 hours with mean 32.657 ± 32.838 hours. The laboratory time ranged from 48 to 70 minutes with mean 56.943 ± 4.943 minutes and computed tomography time ranged from 15 to 40 minutes with mean 27.271± 5.868 minutes. The results revealed that pre hospital delay was due to lake of awareness about stroke symptoms and signs, late decision to seek medical care and lake of transportation by Emergency Medical System, and revealed that in hospital delay due to delayed laboratory investigations and computed tomography completion time. Conclusion: The time interval between the onset of symptoms and the decision to call for medical care was far from optimal in patients with acute stroke, and was the underlying cause of the prolonged pre hospital delay. The present study revealed that all patients arrived at our hospitals were too late to benefit maximally from the emerging stroke therapies.

PRE HOSPITAL AND IN HOSPITAL DELAYS AFTER THE ONSET OF ACUTE ISCHEMIC STROKE IN A SAMPLE OF EGYPTIAN PATIENTS

Background: Cerebrovascular stroke (CVS) is the second most common cause of death after ischemic heart disease and the third most common cause of disability after ischemic heart disease and cancer. Objective: Investigating the time lags and the factors causing pre hospital and in hospital delays after acute ischemic stroke. Patients and Methods: This study included 70 patients recruited from the Neurology Department Al -Azhar University (Al Hussein Hospital) and El Sahel Teaching Hospital during the period from November 2018 to June 2019 with the diagnosis of acute ischemic stroke. Results: The pre hospital time ranged from 6 to168 hours with mean 32.657 ± 32.838 hours. The laboratory time ranged from 48 to 70 minutes with mean 56.943 ± 4.943 minutes and computed tomography time ranged from 15 to 40 minutes with mean 27.271± 5.868 minutes. The results revealed that pre hospital delay was due to lake of awareness about stroke symptoms and signs, late decision to seek medical care and lake of transportation by Emergency Medical System, and revealed that in hospital delay due to delayed laboratory investigations and computed tomography completion time. Conclusion: The time interval between the onset of symptoms and the decision to call for medical care was far from optimal in patients with acute stroke, and was the underlying cause of the prolonged pre hospital delay. The present study revealed that all patients arrived at our hospitals were too late to benefit maximally from the emerging stroke therapies.

101 Impact of a Sobriety Emergency Response Unit on Ambulance Offload Delay in a Large Urban Hospital

Approximately 1% of all emergency department (ED) visits in the United States involve uncomplicated alcohol-related complaints where they may contribute to ED overcrowding and ambulance offload delays (AOD). Since November 2017, a Sobriety Emergency Response (SOBER) Unit, a unique EMS resource staffed with a firefighter/paramedic, a nurse practitioner and caseworker, has been treating and diverting inebriated patients to a sobering center in lieu of the ED. At the sobering center, they can then be connected to appropriate substance abuse and mental health resources.

Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register.

The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.

Factors Influencing Pre-Hospital Delay In Patients with Acute Myocardial Infarction

Acute coronary syndrome is a lethal condition. Treatment modality and success mostly depend on time yielded since onset of symptoms. It is known for more than 30 years that delay between symptom onset and treatment of less than 60 min are desirable, but pre hospital delays remain unacceptably long worldwide including Bangladesh. A greater understanding of the contributing factors may help to reduce delays. A number of sociodemographic, clinical, social and proximal factors have been associated with pre hospital delay. The total pre hospital delay period consists of two component: time taken by patients to recognize that their symptoms are serious and to contact medical help (decision time) and the time taken from requesting help to admission where emergency coronary care is available (time to hospital delay). Different factors may affect these two components. In hospital delay also known as door-to-treatment, is defined as time from arriving to hospital to initiation of reperfusion therapy. Regardless of how to shorten in hospital delay, if the pre hospital delay is not reduced, then reperfusion therapy cannot achieve the best results. We set out to discover what factors are specifically associated with three components: decision time, home to hospital delay and First Medical Contact (FMC) to revascularization delay. This review may help the National health management system to identify the factors associated with treatment delay in ACS and thus reduces ACS related morbidity and mortality.
 University Heart Journal Vol. 15, No. 2, Jul 2019; 79-85

The stroke pathway: an integrated approach to health care of stroke patients.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Clinical and radiological presentation in patients with conserved blunt liver and splenic injuries at a tertiary care center in western India

Background: There has been an increase in abdominal injuries following industrialisation and urbanisation. The mortality due to these injuries however has shown a declining trend worldwide. This is most probably due to early presentation, better access to health care and improved monitoring and treatment modalities.Methods: 51 patients of conserved blunt liver and/or splenic injuries admitted in the trauma ICU of a tertiary care center were studied over a year for demographics, mode of injuries, pre- hospital delay, clinical and radiological presentation.Results: Majority of the patients were males in the age group of 16-30 years. Vehicular accidents were the commonest mode of injuries. Liver was commonly injured. Both liver and spleen were injured in only 3 patients. 20 out of the injured 51 patients received blood transfusion and majority of them had high grade injuries. The severity of injuries was graded with both USG abdomen and CT scan of the abdomen. There was not much difference in grading of liver and splenic injuries by Ultrasound and CT scan.Conclusions: Blunt liver and splenic injuries were commonly seen in young males. Blood transfusion was required in patients with high grade injuries. USG abdomen can be safely used to grade injuries without much discrepancy when compared to CT abdomen.

Transcutaneous Electrical Nerve Stimulation Reduces Resting Pain in Head and Neck Cancer Patients: A Randomized and Placebo-Controlled Double-Blind Pilot Study.

Individuals receiving radiation for head and neck cancer (HNC) often develop painful oral mucositis that impairs function, possibly leading to feeding tubes, hospitalization, and treatment delays. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a safe, nonpharmacologic intervention; it decreases pain and analgesics and improves function, yet no studies examined TENS for HNC. The aim of this study was to examine the efficacy of TENS for pain and function in HNC patients. This study used a randomized, double-blinded crossover design; participants received 3 TENS treatments during weeks 4 to 6 of radiation: active, placebo, and no TENS over the temporomandibular joint and upper cervical region. Pain (McGill Pain Questionnaire, visual analog scale [VAS] resting and function), function (mouth opening, tongue movement, speaking), fatigue (VAS), and treatment effectiveness (VAS) were assessed before and after TENS at 3 visits. Resting pain (McGill Pain Questionnaire and VAS) decreased significantly more after active TENS than placebo or no TENS; changes in function and pain with function did not differ between conditions. Active TENS decreased fatigue significantly more than no TENS and was rated as more effective than placebo TENS. Transcutaneous electrical nerve stimulation improves pain in HNC patients receiving radiation but not function or pain with function relative to placebo or no TENS. Transcutaneous electrical nerve stimulation may be a viable tool for radiation-induced HNC pain to complement pharmacologic approaches. This nonpharmacologic intervention could decrease the debilitating effects of radiation and analgesics, and improve quality of life. Clinical trials should examine the effects and safety of repeated, daily TENS in HNC patients receiving radiation.

Study of clinical outcomes of patients suffering from acute Myocardial Infarction in Pravara Rural Hospital, Loni

Study of clinical outcomes of patients suffering from acute Myocardial Infarction in Pravara Rural Hospital, Loni - IJCAAP- Print ISSN No: - 2581-5555 Online ISSN No:- 2456-9542 Article DOI No:- 10.18231/j.ijcaap.2019.005, IP International Journal of Comprehensive and Advanced Pharmacology-IP Int J Compr Adv Pharmacol

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

ObjectiveTo investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis.MethodsNewly presenting adults with either RA or unclassified arthritis...

Prehospital and hospital delays for stroke patients treated with thrombolysis: A retrospective study from mixed rural–urban area in Northern Finland

BackgroundThrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients. MethodsPatients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied. ResultsThree hundred one stroke patients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients. ConclusionsPositive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time.

Clinico-Epidemiological Profile of Snake Bite Patients in a Tertiary Healthcare Centre in South India

Introduction: Snake bite is a common medical emergency affecting the rural poor. India has the highest rates of envenomation with 81,000 envenomation and 11,000 deaths. Such high figures in spite of availability of antivenin is a cause for concern. The availability of medical records of the victims of snake bite enabled the analysis of the factors contributing to such high mortality and morbidity associated with snake bite. Aims and Objectives:To study the prevalence of poisonous and non-poisonous snake bites in the part of Coastal Karnataka with reference to age, sex, occupation, part of body bitten, time of bite and seasonal variation. To know the systemic envenomation of various types of poisonous snakes and their effective management in reducing the mortality and morbidity rate. To have a common knowledge of the types of poisonous snakes common in this locality and their clinical manifestations. To study the socio-economic impact of snakebite cases in the region. Results: A total of 454 case records were analyzed from 2010 to 2014. 9.69% of the victims died. Male to female ratio was 2.19:1. The highest incidence was between the ages 31 and 40 which was 19.82 %( n=90). Fang marks were recorded in 45.38% of the cases. 16.9% of them reported to a hospital within an hour of the bite. 33.03% reported within 24 hours of the bite. In 65.41% of the cases, the site of snake bite was found to be the lower limb. 23.8 %( n=50) of the identified snakes were cobras. 66.66% (n=140) were vipers. 28.64% of the bites occurred between 18:00 hours and 0:00 hours. 33.92% (n= 154) of the incidents occurred outdoors. Ayurvedic medication was given in 38.23% while a tourniquet was tied in 29.41% of cases. 15.19% of the cases had haemotoxic manifestations while 18.9% had neurological manifestations. 77.5% had local reactions. Conclusion: Snake bite is an important occupational hazard that causes preventable death and disability. Delay in hospitalization, use of traditional medicine and infection are factors contributing to significant mortality and morbidity. Awareness regarding outdoor safety and early hospitalization can significantly reduce the incidence of snake bite.

Le délai diagnostique des cancers broncho-pulmonaires vus à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar

Le délai entre l'apparition des premiers signes cliniques et le diagnostic du cancer bronchique doit être le plus court possible afin que l'on puisse le prendre en charge de façon précoce et efficace. À Madagascar ce délai diagnostique reste inconnu d'où cette étude qui a pour objectif d'évalué le délai diagnostique des cancers broncho-pulmonaires vu à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar. Il s'agit d'une étude rétrospective, descriptive portant sur les cancers broncho-pulmonaires diagnostiqués au sein de l'USFR de Pneumologie Befelatanana pendant la période du 1er janvier 2011 au 31 décembre 2015 (5 ans). Nous avons inclus dans l'étude tous les patients hospitalisés pendant la période d'étude et ayant un diagnostic de cancer broncho-pulmonaire avec preuve anatomopathologique. Durant la période de notre étude, nous avons colligé 43 patients présentant un cancer broncho-pulmonaire confirmé histologiquement, soit 0,64% des patients hospitalisés. Le délai pré-hospitalier, le délai hospitalier et le délai total étaient respectivement de 171,74 jours, 13,97 jours et 185,71 jours. Le délai entre l'apparition des premiers symptômes et la consultation chez un médecin était moins de trois mois dans 30 cas (69,76%), entre 3 et 6 mois dans 8 cas (18,60%). Notre délai pré-hospitalier chez nos patients était très long par rapport à la recommandation internationale sur le délai diagnostique des cancers broncho-pulmonaire. Un effort doit être fait à ce niveau pour améliorer le délai diagnostique.

Post-thyroidectomy Hypocalcemia - Risk Factors and Management.

The complications of thyroidectomy vary from hypocalcemia and recurrent laryngeal nerve lesions to injury of vocal folds, local hematoma, cysts, granuloma. Post-operative hypocalcemia has an incidence of 1.2-40%. Permanent hyoparathyroidism is registered in 3% of cases. This is a brief narrative review focusing on the levels of calcium after performing a thyroidectomy and the need of calcium supplements under these circumstances. This complication, even it seems rather harmless at first, in fact it represents an important contributor to hospitalization delay and, especially for severe forms, to poor quality of life, including the risk of life threatening episodes. Devascularisation of parathyroid glands in addition to injury or dissection causes hypoparathyroidism. Hypocalcemia risk differs with sex (females have a higher risk), lymph node dissection (it increases the risk), it differs with type of thyroidectomy (larger dissections have a higher risk; also the intervention for recurrent goitre and second intervention for post-operatory bleeding increase the risk of hypocalcemia; while Basedow disease is probably at higher risk than multinodular goitre among benign conditions) and the duration of procedure. Pre-operatory low calcium, parathormon (PTH), 25-hydroxivitamin D increases the risk. The calcium drop rate matters as well: a decrease of 1 mg/dL calcium over 12 hours after surgery is independently correlated with the risk of symptomatic hypocalcemia. Early post-operatory PTH and calcium are best predictors for the need of oral calcium supplements. Routine post-operatory calcium and vitamin D supplementation statistically significant decreases the risk of developing transitory hypocalcemia and acute complications compare to calcium alone supplements or no supplements. In cases of hypoparathyroidism calcitriol is preferred.

The hidden health care costs of power of attorney legislation in Scotland: what needs to be done?

Current power of attorney legislation in many European countries seeks to protect the rights of adult patients who lack capacity by ensuring that discharge from hospital to an alternative care setting only occurs when there is legal authority to do so, via a named guardian or power of attorney. In Scotland, a clause introduced in 2007 allows some patients who lack capacity to be transferred from hospital to a community care service provided all relevant parties are agreed that this is in keeping with the legislation (the ‘least restrictive option’) and the patient does not resist the move. However, there is variation in the understanding and use of this clause by local authorities across Scotland, often resulting in avoidable hospital delays, which are costly and cause ‘bed blocking’. This essay illustrates the costs of hospital delays due to current power of attorney legislation in Scotland and highlights the need for the systematic monitoring of power of attorney data and related hospital delays, and for alternative legislation to be considered in the future.

A case of the syndrome of inappropriate antidiuretic hormone secretion treated successfully with Tolvaptan to prevent hospital admission and delay chemotherapy treatment in patient with a small cell lung cancer. Kamal Abouglila Diabetes centre, University Hospital of North Durham, Durham

A case of the syndrome of inappropriate antidiuretic hormone secretion treated successfully with Tolvaptan to prevent hospital admission and delay chemotherapy treatment in patient with a small cell lung cancer. Kamal Abouglila Diabetes centre, University Hospital of North Durham, Durham

Neighbourhood Care Development in Inverness, Highland, Scotland

Introduction: NHS Highland is responsible for the delivery of all adult health and social care services in this area with the Highland Council responsible for the delivery of children’s services under a Lead Agency model developed as part of health and social care integration in 2012. Whilst integration had brought together adult health and social care services into a single organisation the real benefit was not realised in Inverness due to the comparatively large size of the teams this created. There was an extended length of stay in hospital and waiting lists for assessment and commencement of care packages. Description of practice change: From 2 large district teams 7 community neighbourhood teams were formed with a single referral route to each team. The teams are responsible for all aspects of caseload management with decision making supported by multi-professional huddles. Work in progress to support the teams includes the introduction of an electronic record MORSE, the inclusion of independent care at home providers in huddles, community asset building with Inverness Community Planning Partnership, coaching development for managers and the development of team performance and governance information. Aim and Theory of change: The change is based on the principles of the Buurtzorg model of neighbourhood care in the following ways, Autonomous team decision making and caseload management Neighbourhood teams with a community asset approach to delivering and sustaining care. Coaching enabling team function and efficiency. The aim is to prevent unnecessary admission to hospital and care homes, prevent delay in hospital, provide palliative, preventative and rehabilitative treatment for the neighbourhood population through the effective use of combined team and community resources. We aim to improve staff and patient experience by increasing face to face time between staff and patients and reducing bureaucracy and duplication. Targeted populations and stakeholders: All adults requiring health or social care support in Inverness. Stakeholders are community team members, managers, GPs, independent sector care providers, acute and community hospitals in Inverness. Timeline: The model has been developing since 2016 with further supporting changes planned over the next year. Highlights: Builds on the foundations laid by the formation of the Lead Agency model which has not required cross organisational boundary work so restructure has been quick to effect. Comment on sustainability: The model requires organisational and community planning support to be sustainable. Comment on Transferability: Readily transferable to other integrated teams with effective cross-organisational working. Conclusion: These are early days but the smaller teams have embraced the change with a real sense of responsibility for supporting their local communities. Metrics are in place to measure the impact which will be reported on in due course. Discussions: What level of autonomy is desirable and possible in NHS organisations? Challenges for social care inspection and registration bodies. Lessons learned: Large teams lead to silo working. Clearer focus on meeting outcomes requires not just multidisciplinary but joint multi-agency and community engagement in its widest sense to be successful.

Factors Causing Delays and Barriers to Early Diagnosis and Treatment Among Women With Breast Cancer in Shwe Yaung Hnin Si Cancer Foundation Charity Clinic, Yangon

Background: Breast cancer is the most common cancer among females in Myanmar but patients often receive treatment rather late. Delays in seeking treatment of breast cancer for a period longer than 3 months, is associated with lower survival. Hence it is important to find out the causes of the delays so that necessary measures may be implemented with a view to improving treatment outcome. Aim: To explore the delays and barriers to early diagnosis and treatment among the breast cancer patients in Yangon. Methods: A mixed method design. All breast cancer patients (total 104) participated in the structured interview and (16) in the Focus Group Discussion (FGD) sessions. Site at Shwe Yaung Hnin Si Cancer Foundation's Charity clinic from September 2017 to February 2018. Results: Some 32.4% had (patient delay - consulted a medical personnel more than 3 months after noticing signs and symptoms), 19.4% had (general practitioner (GP) delay- to refer to cancer specialist) and 44.4% had (hospital or system delay –i.e., treatment delay after first consultation with specialists). Reasons for patient delay were not knowing that painless small breast lump could be serious (37.5%), socioeconomic constraints (18.8%), too busy working (9.4%) too scared (7.8%) and too shy (4.7%). People living in Yangon had 3.8 times less delay than those living outside (OR 3.8, χ2 = 7.4, P < 0.004); those unemployed were 2.4 times less delay than used (OR 2.4, χ2 = 3.77, P < 0.02); negative attitude toward breast lump and being worried had 8 times less chance of patient delay (OR= 8, χ2=19.9, P ≤ 0.0001). Those who perceived that a painless breast lump was serious are 8.8 times less likely to have patient delay (OR 8.8, χ2 = 3.08, P < 0.001). The odds of having GP delay are 3.2 times higher among those having patient delay (OR=3.2, χ2=5.6, P < 0.02). By FGD most of the survivors revealed reasons for delay which were limited information, economic, use of traditional medicine and sociocultural issues. Conclusion: Lack of knowledge was the highest cause of the patient delay, followed by perception, socioeconomic factors and accessibility to health care and so these need to be overcome. The GP delay and system delay need to be further explored to ascertain the exact causes.

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil

ObjectiveTo identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0–29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. MethodsPatient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. ResultsThere was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. ConclusionHealth care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

P147: Clinical characteristics and system factors of elderly treated for agitation in the emergency department: a data driven approach

Introduction: Aligning health systems appropriately to the needs of the elderly is an urgent global priority, according to the WHO. In Canada, ED length of stay has risen 16% for elderly patients in the last year. Agitation requiring chemical restraint is a common, high-risk problem for elderly in the ED. Improving outcomes in this heterogeneous population remain difficult due to inability to effectively identify and evaluate delirium, frailty, multi-morbidity, and incompatibility with the ED system. A data-driven approach to complex health problems is a recognized emerging tool for healthcare innovation. New opportunities for targeted quality improvement in the ED will be uncovered by identifying the clinical characteristics of elderly patients with agitation, and the system process factors that influence their outcomes. Methods: We studied 400 patients in a case-control study at two tertiary-care EDs over five years. Patients were randomly selected if age was greater than 75 years. 200 cases of patients who received an intravenous dose of haloperidol, midazolam and/or lorazepam were selected as a surrogate data marker for having agitation. Controls were randomly matched by age and ED diagnosis. Standardized clinical, systems and process variables were collected. We conducted a univariate analysis. Results: Elderly given intravenous medications for agitation had increased mortality (OR 3.8 CI: 1.6-10.7, p<0.001) and ED length of stay (27 vs. 15 hours, p<0.001). No statistical significance was found in clinical characteristics, CTAS scores, PRISMA7 frailty scores nor sentinel or return visits. There was no statistical difference in median hospital length of stay (8 vs. 6 days, p<0.70). No differences were found in median time from ED physician seeing a patient to first consultant request (73 vs. 83 mins, p=0.75). The largest time intervals contributing to ED length of stay were from first consultant request to hospital request (15 vs. 12 hours, p=0.056) and hospitalization delay (13 vs. 7 hours, p=0.45). Conclusion: Identification of high-risk elderly patients for targeted intervention through a data-driven approach is feasible and informative. Traditional clinical characteristics remain unhelpful in identifying and evaluating outcomes in elderly with agitation. We have identified a process factor that is clinically relevant and pragmatic to evaluate in our ED system. Future research focused on optimizing systems process factors to improve quality of elderly care should be prioritized.