Number Of Emergency Department Admissions Research Articles

Air purifiers for reducing the incidence of acute respiratory infections in australian residential aged care facilities: A study protocol for a randomised control trial.

Adults living in Residential Aged Care Facilities (RACFs) are highly susceptible to seasonal respiratory infections. Evidence indicates that the aerosols contaminated with virus particles in closed indoor spaces may play a significant role in the transmission of respiratory infections. In this protocol paper, we outline details of a planned RCT which aims to evaluate the effectiveness of portable in room air purifiers in reducing the risk of ARIs among residents in Australian RACFs. This study uses a multi-centre double-blind randomised crossover design. Three RACFs in a regional area of New South Wales will be invited to participate in the study. Air purifiers with or without high-efficiency particulate absorbing (HEPA) filters will be placed in the rooms of residents who are enrolled in the trial. The primary outcome will be a reduction in the incidence of ARI and the secondary outcomes will be the time to first infection, number of emergency department admissions, hospital admissions, and medical consultations due to an ARI. To our knowledge, this will be the first RCT using air purifiers in resident rooms to identify their effect in reducing ARIs in RACFs. If our findings indicate some potential benefit for in-room air purification, it will help provide support and justification for larger trials, which may include a facility wide approach to air purification.

#4752 EMERGENCY DEPARTMENT VISITS IN PERITONEAL DIALYSIS PATIENTS: A SINGLE CENTER STUDY DURING AN 8-YEAR PERIOD

Abstract Background and Aims Peritoneal dialysis patients may present to the emergency department (ED) with infectious, mechanical and metabolic complications of dialysis, as well as non-dialysis-related problems. We planned to retrospectively analyse ED visits in PD patients. Method Study included 189 PD patients followed between December 2014 and July 2022. Patients younger than 18 years and with less than 1-month follow-up were excluded. Demographic characteristics, co-morbidities, medications, dialysis modalities, laboratory tests, presenting symptoms, diagnoses and patient endpoints were evaluated. Results There were 32 (16.9%) female and 157 (83.1%) male patients. Patients were divided into two groups as those who applied to the ED (n = 109) or not (n = 80). Median age (47 (19-80) vs 52.5 (26-77) years, p = 0.389) and dialysis duration (42 (1-248) vs 20.5 (1-217) months, p = 0.390) were similar in both groups. Most common comorbidities were anaemia (103 (94.5%) vs 75 (93.8%), p = 1,000), hypertension (90 (82.6%) vs 64 (80%), p = 0.707) and diabetes mellitus (23 (21.9%) vs 17 (21.3%), p = 1,000). While mortality (39 (35.8%) vs. 16 (20%), p = 0.013) was significantly higher in patients presenting to ED, transfer to hemodialysis (29 (26.6%) vs 33 (41.3%), p = 0.008) and transplant (4 (3.7%) vs 12 (15%), p = 0.042) were lower. There were 248 ED admissions for 109 patients during follow-up. Ninety-two (37.1%) episodes required hospitalization, whereas 156 (62.9%) episodes were treated as outpatients. Mean hospital stay was 10.5 (1-103) days. Most common reasons for admission were abdominal pain, cloudy dialysate, nausea and/or vomiting in 111 episodes (44.8%), cardiovascular symptoms in 31 episodes (12.5%) and hypervolemia in 29 episodes (11.7%). Most common diagnoses were peritonitis in 61 (24.6%), hypervolemia in 32 (12.6%), and upper respiratory tract infection in 21 (8.5%) episodes. When patients were evaluated based on hospitalization status, mean patient age was higher in hospitalized patients (55 (17-84) vs 49 (15- 87) years; p = 0.029), whereas residual renal function (RRF) was lower (150 (0-2500) vs 300 (0-9500) mL /day; p = 0.048). Laboratory data is shown in Table 1. In multivariate analysis, factors predicting hospitalization were CRP [0.991 (0.984-0.997), p = 0.003] and magnesium [5.315 (1.423-19.853), p = 0.013]. Patients presenting to ED were also evaluated based on mortality during follow-up and 39 (35.8%) out of 109 patients died. There was no difference in terms of patient age (p = 0.525), gender (p = 0.792), dialysis time (p = 0.536) or RRF (p = 0.377). However, number of ED admissions was significantly higher in patients who died (2.81±1.63 vs 1.99±1.26; p = 0.004) and the only factor predicting patient death was the number of ED admissions [1.603 (1.058-2.430) p = 0.026]. Conclusion The most common symptoms associated with ED admissions were gastrointestinal and the most common diagnosis was peritonitis. In patients presenting to the ED, more than a third required hospitalization. Factors predicting hospitalization were high CRP and low magnesium levels. The number of admissions to the ED was the only factor that predicted death during follow-up.

Telemonitoring in Heart Failure - A Single Center Experience.

ResumoFundamentoA evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente.ObjetivosEste estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência.MétodosEste é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo.ResultadosUm total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas.ConclusõesEste estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.

Forecasting emergency department admissions

The emergency department of a hospital plays an extremely important role in the healthcare of patients. To maintain a high quality service, clinical professionals need information on how patient flow will evolve in the immediate future. With accurate emergency department forecasts it is possible to better manage available human resources by allocating clinical staff before peak periods, thus preventing service congestion, or releasing clinical staff at less busy times. This paper describes a solution developed for the presentation of hourly, four-hour, eight-hour and daily number of admissions to a hospital’s emergency department. A 10-year history (2009–2018) of the number of emergency admissions in a Portuguese hospital was used. To create the models several methods were tested, including exponential smoothing, SARIMA, autoregressive and recurrent neural network, XGBoost and ensemble learning. The models that generated the most accurate hourly time predictions were the recurrent neural network with one-layer (sMAPE = 23.26%) and with three layers (sMAPE = 23.12%) and XGBoost (sMAPE = 23.70%). In terms of efficiency, the XGBoost method has by far outperformed all others. The success of the recurrent neuronal network and XGBoost machine learning methods applied to the prediction of the number of emergency department admissions has been demonstrated here, with an accuracy that surpasses the models found in the literature.

Oncology workload in a tertiary hospital during the COVID-19 pandemic

IntroductionWorkload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients.MethodsThis study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009.ResultsOur data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology −18.5% inpatient and −3.8% outpatient, internal medicine −5.7% inpatient and −24.4% outpatient, general surgery −17.6% inpatient, and −39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19.DiscussionWe conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic.

The Association between Adenotonsillectomy and Frequency of Vaso-Occlusive Crises in Patients with Sickle Cell Disease.

Sickle cell disease (SCD) typically manifests in early childhood as attacks of pain known as vaso-occlusive crises. Infection and hypoxemia have been linked with these recurrent episodes and with prolonged hospitalization in SCD patients. However, adenoids and tonsils as sources of infection and causes of hypoxemia have not been adequately investigated in association with vaso-occlusive crises in SCD. To assess the association between adenotonsillectomy and frequency of vaso-occlusive crisis in SCD patients who underwent this procedure at our Hospital, and between adenotonsillectomy and frequency of blood transfusions and emergency department and intensive care unit admissions. We used medical record data to conduct a retrospective review of SCD patients who underwent adenoidectomy and/or tonsillectomy between 2005 and 2017. Eligible subjects were assessed for frequency of vaso-occlusive crises, blood transfusions, and emergency department and intensive care unit admissions. Using the Wilcoxon signed rank test, we compared the frequencies of each outcome preoperatively and 1, 3, 5, and 10years postoperatively. Of 524 records reviewed, 40 eligible patients were included in the study. Minimal reduction was observed in the frequency of vaso-occlusive crisis episodes within 1 and 3years after adenotonsillectomy (p = 0.337 and p = 0.549, respectively). Although the 5- and 10-year postoperative vaso-occlusive crisis frequency tended to be higher than that in the preoperative period, none of the results reached statistical significance. The number of emergency department admissions showed a statistically significant increase 3years postoperatively compared with that in the preoperative period (P = 0.043). There were no statistically significant differences in perioperative blood transfusion frequency or number of intensive care unit admissions in any period. Adenotonsillectomy in SCD patients does not seem to be related to the frequency of vaso-occlusive crises, blood transfusions, or emergency department or intensive care unit admissions. Prospective studies with larger sample sizes are recommended to further evaluate these findings.

Forecasting emergency department admissions

The emergency department of a hospital plays an extremely important role in the healthcare of patients. To maintain a high quality service, clinical professionals need information on how patient flow will evolve in the immediate future. With accurate emergency department forecasts it is possible to better manage available human resources by allocating clinical staff before peak periods, thus preventing service congestion, or releasing clinical staff at less busy times. This paper describes a solution developed for the presentation of hourly, four-hour, eight-hour and daily number of admissions to a hospital’s emergency department. A 10-year history (2009-2018) of the number of emergency admissions in a Portuguese hospital was used. To create the models several methods were tested, including exponential smoothing, SARIMA, autoregressive and recurrent neural network, XGBoost and ensemble learning. The models that generated the most accurate hourly time predictions were the recurrent neural network with one-layer (sMAPE = 23.26%) and with three layers (sMAPE = 23.12%) and XGBoost (sMAPE = 23.70%). In terms of efficiency, the XGBoost method has by far outperformed all others. The success of the recurrent neuronal network and XGBoost machine learning methods applied to the prediction of the number of emergency department admissions has been demonstrated here, with an accuracy that surpasses the models found in the literature.

Acil Servisten İstenen Genel Cerrahi Konsültasyonları: Pandemi ve Pandemi Dışı Dönemin Analizi

Objective: To investigate the emergency department admissions, the general surgery consultation request, and the necessity of immediate treatment of patients despite the fact that the society did not leave the house unless necessary during the pandemic period. Methods: The files of patients who admitted to the emergency department and whose general surgery consultation was requested due to urgent surgical treatment were retrospectively scanned between March-May 2020, which is the Covid 19 pandemic period and March-May 2019, as a time period in which normal social life continues. Age, gender, complaints, comorbid diseases, the necessity of truly emergency surgical treatment as well as the socioeconomic level scale for each individual were recorded and analyzed. Results: The rate of request for consultation was 2.7% (n = 170) in the pandemic period, and 3.1% (n = 316) in the non-pandemic period. In both periods, no statistically significant difference was found in the distribution of genders according to the treatment(p&amp;gt; 0.05). The complaints of the patients were similar in both periods, and the most common complaints were nausea-abdominal pain-difficulty defecation. Although individuals without comorbidities are predominant in both periods, the proportion of individuals with comorbid diseases was higher during the pandemic period (p = 0.001). Patients who did not require urgent treatment in both periods were in the majority. In patients requiring urgent treatment, the rate of the hospitalized patients was higher during the pandemic period, whereas the rate of the operated patients was higher in the non-pandemic period (p = 0.005). The majority of the patients had a low socioeconomic level and a small portion had a moderate socioeconomic level in both periods (p&amp;gt; 0.05). In addition, patients with a low socioeconomic level and 75 years of age or older who did not require urgent treatment were higher in the pandemic period (p = 0.002). Conclusion: Although there is a significant decrease in the number of emergency department admissions and the number of general surgical consultations requested during the pandemic period, the fact that more than half of the patients who are consulted do not require emergency surgical treatment still shows the unnecessary use of emergency services.

Impact of COVID-19 pandemic on hand injuries.

The aim of the study was to evaluate etiologies of hand injuries in emergency department (ED), to compare the etiologies of hand injuries at the time of this study with the previous year, to assess whether novel coronavirus-2019 (COVID-19) pandemic affected the treatment decisions, and to investigate the COVID-19 infection rate within the first 14 days after admission. A total of 229 patients admitted to ED with hand injury between March 15 and April 30, 2020, were included in the study. The control group consisted of 439 ED admissions with hand injury in the previous year (March 15-April 30, 2019). Data including age, sex, cause of trauma, treatment, and COVID-19 infection status within 14 days after ED admission were compared between groups. The mean age was 32.30±15.63 years in the study group and 30.85±18.54 years in the control group. The number of patients consulted to the surgery department decreased by 52.6% and the number of patients admitted to ED with hand injuries de-creased by 47.6% during the pandemic, compared to the previous year (p=0.0001). The incidence of home accidents increased and the glass cuts and penetrating/perforating injuries were the most common causes during the pandemic most of which occurred at home. The COVID-19 pandemic-mandated social restrictions led to a significant decrease in the number of ED admissions with hand injuries and the type of injuries. The incidence of home accidents increased with more time spent indoors. This study may be a useful guide for ED admissions of hand injury cases and management planning in the current and future pandemics.

The Effect of Curfew Enforcement on Health Care Provision in COVID-19 Pandemic

The COVID-19 disease occurred in the final weeks of 2019. As part of the fight against COVID-19, countries have taken actions such as travel restrictions, suspension of border crossings and international flights, voluntary home isolation, public activities restriction, and curfews. The objective of this study is to identify the effect of curfew enforcement during the COVID-19 pandemic to determine and identify whether curfew has a positive effect on the health care workload. The number of patients admitted to Sakarya University Training and Research Hospital, their means of arrival, hospitalization-discharge, demographic characteristics were examined retrospectively for the period of curfew in April and May 2020 and the corresponding days in 2019. The significant statistical differences between the two periods were analyzed. The results of this research reveal that24.488 patients were admitted to our emergency department. Of these patients, 12813 (52.3%) were male, 11675 (47.7%) were female. The number of emergency department admissions of the pediatric age group decreased from 1822 (8.9%) to 33 patients (0.8%). Moreover, the number of patients admitted to the emergency service in the related period of 2019 was 20548 (83.9%), while this figure decreased to 3940 individuals (16.1%) during the curfew period. It was impliedthat curfew could reduce the unnecessary admissions to hospitals, the number of ambulance usage, and provide a positive contribution to the reduction in traumas, car accidents, work accidents, and forensic cases during pandemic.

What is the emergency application differences concerning diseases pertinent to the chest between Turkish citizens and Syrian refugees: A cross-sectional study.

Millions of Syrians were displaced after the Syrian civil war broke in 2011. Turkey hosts the largest number of refugees. This study aimed to describe the disease patterns of Syrian refugees applying to an emergency department. The study included patients who presented to an emergency department between 2017 and 2018. Study data were retrieved from the hospital's electronic medical records registry. The main study outcome was the ICD-10 codes pertinent to "chest diseases." Additionally, analyzed data were nationality, age, sex, triage status on admission, hospitalization status, and examination date. The number of emergency department admissions included in the study period was 378 487 persons, of which 14 262 (3.8%) were Syrian refugees. A total of 62 345 diagnoses (16.5%) were related to the respiratory system. Turkish patients had a significantly higher median age than Syrian refugees. Also, there were significantly more women among Syrian applicants, and acute bronchitis and asthma were more common among Syrian patients. However, the hospitalization rates were similar between the two groups. Moreover, Syrian patients had more applications during the summer seasons and had higher "Yellow" labels in the emergency triage. There are differences in the disease patterns of Syrian refugees and Turkish citizens applying to the emergency department. This may be explained by the difficulty in communication which, to our opinion, may be reversed as language barriers are overcome and adaptation to the society is completed over time.

More MS nurses needed to reduce waiting lists.

New analysis shows the number of emergency department admissions for people with multiple sclerosis (MS) continues to rise, costing the NHS millions.

A new strategy for emergency department crowding: High-turnover utility bed intervention

BackgroundThis study applied a new strategy, termed high-turnover utility bed intervention, to offer early admission chances for emergency department (ED) patients and alleviate ED crowding. MethodsThis before-and-after observational cohort study was conducted at the ED of an urban tertiary hospital. On January 1, 2012, 14 utility beds were prepared exclusively for ED patient use. A strict 48-hour course limit for each patient was formulated to govern these high-turnover beds. The primary outcome measure for this study was ED length of stay. Secondary outcome measures were the number of ED admissions, patients who left without being seen, and revisits within 72 hours of discharge, as well as the outcomes of cardiac arrest management and ambulance diversion hours. ResultsThere were 70,515 adult ED visits enrolled during the preintervention period (January–December 2011), and 69,706 during the postintervention period (July 2012–June 2013). In the postintervention period, this new strategy offered 1401 early admission opportunities. The ambulance diversion hours decreased prominently from 5.4 hours to 1.6 hours per day. A shortening in ED length of stay from 9.7 hours to 8.0 hours was achieved, mainly in cases of nontrauma. More patients (31.2% vs. 29.7%) were admitted to the wards with a lower discharge rate in the postintervention period. Additionally, there was no difference in ED revisit within 72 hours and cardiac arrest management. ConclusionThe high-turnover ED utility bed intervention offered improved admission chance and alleviated ED crowding output. ED efficiency improved, with shortened ED length of stay and fewer ambulance diversion hours.

Mental and Nonmental Health Hospital Admissions among Chronically Homeless Adults Before and After Supportive Housing Placement

Individuals experiencing chronic homelessness may utilize hospital services more frequently than the general population. Understanding the benefits of providing permanent supportive housing to these individuals can lead to improved services for this population. This study examined the effect of supportive housing placement on hospital admissions of adults who were homeless. Admissions were examined for a period of one-year pre- and postsupportive housing placement for 23 adults. Results showed a reduction in the number of emergency department admissions and an increase in outpatient admissions during the year following housing placement, indicating that supportive housing may encourage more appropriate use of health care services.

Role of smoke-free legislation on emergency department admissions for smoking-related diseases in Kocaeli, Turkey

Legislation banning smoking in all indoor public places was introduced in Turkey in July 2009. The aim of this study was to evaluate the role of smoke-free legislation on the number of emergency department admissions for smoking-related diseases in Kocaeli city. A retrospective analysis was made of hospital records from the first 6 months of 2009 and 2010 (before and after legislation). Total admissions for smoking-related diseases were 83 089 in 2009 and 64 314 in 2010, a 22.6% decrease. Time-series analysis showed that the decreases were significant for bronchitis and lower respiratory tract infections. Emergency admissions for chronic obstructive pulmonary disease, myocardial infarction and allergic rhinitis were lower but not significantly so. The number of patients admitted with asthma showed a non-significant increase. Smoke-free legislation might have important short-term effects on emergency department admissions, but further studies are needed in order to evaluate the long-term effects of legislation on smoking-related diseases.

Pain scores among ED patients: correlation with desire for pain medication

Introduction: Pain has been identified as the most common reason for Emergency Department (ED) visits. The verbal numeric rating pain scale (VNRS) is commonly used to assess pain in the ED. This study was undertaken to determine whether VNRS pain scores correlate with desire for pain medication among ED patients. Methods: In this prospective survey study, eligible patients included Emergency Department patients over 18 with painful conditions. The primary outcome measures included self-reported VNRS, ED diagnosis, number of ED visits and number of ED admissions within the past year, and the self-reported desire for pain medication. Results: Among 482 participants in 2012, the median triage pain score was 8 (IQR 6-10); the most frequently occurring score was 10. Overall, there were significant differences in pain scores with patient desire for analgesics. 67% reported desire for pain medications. Patients who did not want pain medications had significantly lower pain scores (median 6; IQR 4-8) compared to those who wanted medication (median 8; IQR 7-10) (p&lt;0.001) and compared to those who were ambivalent about medication (median 7; IQR 6-10) (p=0.01). There was no association between desire for pain medication and demographics including age, gender, race, or insurance status. Conclusions: ED patients who did not desire pain medication had significantly lower pain scores than patients who desired pain medication. Pain scores usually effectively predicted which patients desired pain medications. Desire for pain medication was not associated with age, gender, race, or insurance status.

Trial to End Ambulance Diversion in Boston: Report from the Conference of the Boston Teaching Hospitals Consortium

Annual ambulance diversion hours in Boston increased more than six-fold from 1997 to 2006. Although interventions and best practices were implemented, there was no reduction in the number of diversion hours. A consortium of Boston teaching hospitals instituted a two-week moratorium on citywide diversion from 02 October 2006 to 15 October 2006. The hypothesis was that there would be no significant difference in measures of hospital and emergency medical services (EMS) efficiency compared with the two weeks immediately prior. A total of nine hospitals and the municipal emergency medical services in Boston submitted data for analysis. The following mean daily hospital measures were studied: (1) emergency department volume; (2) number of emergency department admissions; (3) length of stay (LOS) for all patients; and (4) number of elopements. Mean EMS at-hospital time by destination and the percent of all Boston EMS transports to each hospital destination were calculated. The median differences (MD) were calculated as "before" minus "during" the study period and were compared with paired, Wilcoxon, non-parametric tests. Additional mean EMS measures for all destinations included: (1) to hospital time; (2) number of responses with transport initiated per day; (3) incident entry to arrival; and (4) at-hospital time. The LOS for admitted patients (MD = 0.30 hours; IQR 0.10,1.30; p = 0.03) and number of daily admissions (MD = -1.50 patients; IQR -1.50, -0.10; p = 0.04) were significantly different statistically. The results for LOS for all patients, LOS for discharged patients, ED volume, EMS time at hospital by destination, number of elopements, and percent of Boston EMS transports to each hospital revealed no statistically significant differences. The difference between the study and control periods for mean EMS to hospital time, at-hospital time, and incident entry to arrival was a maximum of 0.6 minutes. The vast majority of EMS respondents to an online survey believed that the "no diversion" policy should be made routine practice. The LOS for admitted patients decreased by 18 minutes, and the number of admissions increased by 1.5 patients per day during the study period. The "no diversion" policy resulted in minimal changes in EMS efficiency and operations. Diversion was temporarily eliminated in a major city without significant detrimental changes in ED, hospital, or EMS efficiency.

Facial Trauma Coverage Among Level-1 Trauma Centers of the United States

A large portion of patients admitted to trauma centers present with isolated or concomitant facial injuries. Multiple surgical specialties including oral and maxillofacial, plastic, and otolaryngology/head and neck surgeons are trained and involved in the management of oral and maxillofacial trauma. The purpose of this study is to evaluate the current distribution of different specialties that cover facial trauma among the leading trauma centers in the United States. Based on the number of emergency department admissions, the 5 busiest hospitals for each state within the United States were determined from the American Hospital Association, representing a total of 255 hospital emergency rooms. Seventy-six (N = 76) level-1 trauma centers were identified by directly contacting the hospital facility. Information was requested by mail from the chief of surgery and emergency medicine department regarding the percentage of facial trauma coverage by the different surgical specialties. In addition, the professional societies representing the 3 main specialties: American Association of Oral and Maxillofacial Surgeons (AAOMS), American Association of Plastic Surgeons (AAPS), and the American Academy of Otolaryngologists/Head and Neck Surgeons (AAO-HNS) were contacted to determine an estimate of the number of active members within each specialty. Information was obtained from 57 (75%) level-1 trauma hospitals. The remaining 19 (25%) hospitals failed to respond to our survey. The distribution of facial trauma coverage by the different specialties was as follows: plastic surgeons, 39.6%; oral and maxillofacial surgeons, 36.6%; otolaryngologists/head and neck surgeons, 23.3%; and other services (general surgery and oculoplastics), 0.5%. According to the respective professional societies contacted, there are approximately 7,003 plastic surgeons, 6,377 oral and maxillofacial surgeons, and 7,720 head and neck surgeons that are practicing members of their respective societies. Treatment of facial trauma is an essential and demanding aspect of all the surgical specialties that provide this service. All major trauma centers require the support of facial trauma specialists for management of these injuries. When considering the ratio of surgeons per specialty and the percentage of facial trauma coverage provided by each specialty, oral and maxillofacial surgeons and plastic surgeons provide the greatest proportion of facial trauma coverage among the level-1 trauma centers that participated in the survey.

265: Effect of Hospital Occupancy Rate, Number of Emergency Department Admissions, and Number of Elective Hospital Admissions on Patients’ Length of Stay in an Academic Emergency Department

265: Effect of Hospital Occupancy Rate, Number of Emergency Department Admissions, and Number of Elective Hospital Admissions on Patients’ Length of Stay in an Academic Emergency Department

Time Series Analysis of Variables Associated With Daily Mean Emergency Department Length of Stay

We measure the effect of various input, throughput, and output factors on daily emergency department (ED) mean length of stay per patient (daily mean length of stay). The study was a retrospective review of 93,274 ED visits between April 15, 2002, and December 31, 2003. The association between the daily mean length of stay and the independent variables was assessed with autoregressive moving average time series analysis (ARIMA). The following independent variables were measured per 24-hour period: number of elective surgical admissions, ED volume, number of ED admissions, number of ED ICU admissions, number of ED clinical attending hours, hospital medical-surgical occupancy (hospital occupancy), and day of the week. Three factors were independently associated with daily mean length of stay in time series analysis: number of elective surgical admissions, number of ED admissions, and hospital occupancy. The daily mean length of stay increased by 0.21 minutes for every additional elective surgical admission, 2.2 minutes for every additional admission, and 4.1 minutes for every 5% increase in hospital occupancy. Elective surgical admissions were associated with a maximum of 35 hours of additional ED dwell time. The model accounted for 31.5% of the variability in daily mean length of stay. The final model parameters for the ARIMA analysis were autoregressive term (1) moving average (1). Hospital occupancy and the number of ED admissions are associated with daily mean length of stay. Every additional elective surgical admission prolonged the daily mean length of stay by 0.21 minutes per ED patient. Autocorrelation exists between the daily mean length of stay of the current day and the previous day.