Independent determinants of prolonged emergency department length of stay in a tertiary care centre: a prospective cohort study
| Autor: | Anne J. Fogteloo, Bas de Groot, C. Heringhaus, Claudia Remeijer, Daniël van der Veen |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Clinical Decision-Making Specialty Critical Care and Intensive Care Medicine Logistic regression Overcrowding Tertiary Care Centers Young Adult 03 medical and health sciences Patient safety 0302 clinical medicine medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Referral and Consultation Aged Emergency department business.industry lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Odds ratio Length of Stay Middle Aged medicine.disease Comorbidity Patient Discharge Intensive Care Units Emergency department length of stay Emergency medicine Emergency Medicine Female Emergency Service Hospital business |
| Zdroj: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 26, Iss 1, Pp 1-9 (2018) |
| ISSN: | 1757-7241 |
| DOI: | 10.1186/s13049-018-0547-5 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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