What is the clinical evidence from this study?

Study design: Cohort. Population: Emergency department patients (n=1434). Intervention: Consultations in the ED vs. No consultations. Primary outcome: Emergency department length of stay > 4 hours (AOR 5.90, 95% CI 4.08-8.54).

September 20, 2018Open Access

Independent determinants of prolonged emergency department length of stay in a tertiary care centre: a prospective cohort study

Key Result

Consultations in the emergency department were the strongest independent determinant of a prolonged length of stay >4 hours (AOR 5.90), followed by blood testing (AOR 3.45) and radiology imaging (AOR 3.02).

Study Design

Type

Cohort (n=1,434)

Multicenter

Structured PICO

Population

1,434 consecutive emergency department patients presenting to a Dutch tertiary care center between 10 a.m. and 10 p.m. over 30 randomly chosen days.

Outcome

Total emergency department length of stay (ED LOS) of more than 4 hours

Laboratory/radiology testing and consultations are the most important independent determinants of prolonged emergency department length of stay, consuming up to 66% of the total ED time.

Main Result

Odds Ratio: 5.9 (95% CI 4.08–8.54)

Limitations

ED crowding was not measured according to a validated crowding score
Results from a tertiary care centre may not be applicable to all hospitals, potentially overestimating the impact of consultations
Sampling method excluded night hours, which could have led to an underestimation of the impact of consultations and diagnostic testing on ED LOS
Potential unmeasured impact of seasonal variation

Abstract

BACKGROUND: Emergency department (ED) overcrowding is a potential threat for patient safety. We searched for independent determinants of prolonged ED length of stay (LOS) with the aim to identify factors which can be targeted to reduce ED LOS, which may help in preventing overcrowding. METHODS: This prospective cohort study included consecutive ED patients in a Dutch tertiary care centre. Multivariable logistic regression analysis was used to identify independent determinants of ED LOS > 4 h, including patient characteristics (demographics, referral type, acuity, (number of) presenting complaints and comorbidity), treating specialty, diagnostic testing, consultations, number of patients in the ED and disposition. Furthermore, we quantified the absolute time delays (measured in real-time) associated with the most important independent determinants of prolonged ED LOS. RESULTS: In 1434 included patients independent determinants of prolonged ED LOS were number and type of presenting complaints, specialty, laboratory/radiology testing and consultations, and ICU admission. Modifiable determinants with the largest impact were blood testing; Adjusted odds ratio (AOR (95%-CI)); 3.45 (1.95-6.11), urine testing; 1.79 (1.21-2.63), radiology imaging; 3.02 (2.13-4.30), and consultation; 5.90 (4.08-8.54). Combined with the laboratory/radiology testing and/or consultations (requested in 1123 (78%) patients) the decision-making and discharge process consumed between 74 (42%) and 117 (66%) minutes of the total ED LOS of 177 (IQR: 129-225) minutes. CONCLUSIONS: In tertiary care EDs, ED LOS can be reduced if the process of laboratory/radiology testing and consulting is optimized and the decision-making and discharge procedures are accelerated.

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