Analyzing Factors Affecting Emergency Department Length of Stay—Using a Competing Risk-accelerated Failure Time Model

Abstract

Emergency department (ED) length of stay (LOS) is associated with ED crowding and related complications. Previous studies either analyzed single patient disposition groups or combined different endpoints as a whole. The aim of this study is to evaluate different effects of relevant factors affecting ED LOS among different patient disposition groups.This is a retrospective electronic data analysis. The ED LOS and relevant covariates of all patients between January 2013 and December 2013 were collected. A competing risk accelerated failure time model was used to compute endpoint type-specific time ratios (TRs) for ED LOS.A total of 149,472 patients was included for analysis with an overall medium ED LOS of 2.15 [interquartile range (IQR) = 6.51] hours. The medium LOS for discharged, admission, and mortality patients was 1.46 (IQR = 2.07), 11.3 (IQR = 33.2), and 7.53 (IQR = 28.0) hours, respectively. In multivariate analysis, age (TR = 1.012, P < 0.0001], higher acuity (triage level I vs level V, TR = 2.371, P < 0.0001), pediatric nontrauma (compared with adult nontrauma, TR = 3.084, P < 0.0001), transferred patients (TR = 2.712, P < 0.0001), and day shift arrival (compared with night shift, TR = 1.451, P < 0.0001) were associated with prolonged ED LOS in the discharged patient group. However, opposite results were noted for higher acuity (triage level I vs level V, TR = 0.532, P < 0.0001), pediatric nontrauma (TR = 0.375, P < 0.0001), transferred patients (TR = 0.852, P < 0.0001), and day shift arrival (TR = 0.88, P < 0.0001) in the admission patient group.Common influential factors such as age, patient entity, triage acuity level, or arrival time may have varying effects on different disposition groups of patients. These findings and the suggested model could be used for EDs to develop individually tailored approaches to minimize ED LOS and further improve ED crowding status.

Predicting Length of Stay among Patients Discharged from the Emergency Department—Using an Accelerated Failure Time Model

“…In two other studies, one using the Australian Triage System and one using the Canadian Triage Acuity System, a longer ED LOS was found in higher acuity patients [20–22]. Besides triage acuity level, advanced age has also been found to be related to a longer LOS among discharged patients [19, 23, 24]. In our study, after controlling for the effect of disease acuity, exams, or whether a consultation was provided, the effect of age group still showed a significant trend in time ratios.…”

Correlation of Admision Time, Discharge Time and Patients Discharge Type With Length of Stay in Yellow Zone of Emergency Department

“…These results same with the study that explained that there was significant difference in the AVLOS that was found between inpatient (Mean = 544 minutes, SD = 323 minutes) and outpatient (mean = 291 minutes, SD = 286 minutes). This proven that if ED carry out more discharged inpatient compared with outpatients, it would lengthened the LOS of patients in the ED (Chaou et al, 2016).…”

“…patients who are transferred in intensive care. Among the three types of patients discharge type from the ED and their correlation factor for each of them are not same (Chaou et al, 2016).…”

An integrated statistical model of Emergency Department length of stay informed by Resilient Health Care principles

“…those with higher acuity, (Chaou et al, 2016) and those with specific histories including hypertension or atrial fibrillation (Rashid et al, 2013) show longer length of stay. Other barriers to throughput include delayed consultant input (Hosseininejad et al, 2017) or diagnostic tests (Yoon et al, 2003).…”