Factors Associated With Emergency Department Length of Stay for Patients With Hip Fracture

Abstract

Time to surgery, which includes time in the emergency department (ED), is important for all patients with hip fracture. We hypothesized that patients with hip fracture spend significantly more time in the ED than do patients with the top 5 most common conditions. In addition, we hypothesized that there are patient, physician, and hospital factors that affect the length of time spent in the ED. We retrospectively reviewed our institution's hip fracture database and identified 147 elderly patients with hip fractures who presented to our ED from December 18, 2005, through April 30, 2009. We reviewed their records for patient, practitioner, and hospital factors of interest associated with ED time and for 6 specified time intervals. Average working, boarding (waiting for an inpatient room), and total times were calculated and compared with respective averages for admitted ED patients with the top 5 most common conditions. Univariate and multivariate analyses were performed before and after adjusting for confounders (significance, P ¼ .05). The mean total ED time (7 hours and 25 minutes) and working time (4 hours and 31 minutes) for patients with hip fracture were similar to the respective overall averages for admitted ED patients. However, the average boarding time for patients with hip fracture was 2 hours 44 minutes, longer than that for other patients admitted through the ED. Factors significantly associated with longer ED times were a history of hypertension, history of atrial fibrillation, the number of computed tomography scans ordered, and the occupancy rate. Admission to the hip fracture service decreased working time but not overall time. Substantial multidisciplinary work among the ED, hospital admission services, and physicians is needed to dramatically decrease the boarding time and thus the overall time to surgery.

Patient characteristics associated with longer emergency department stay: a rapid review

“…No study of the general patient population considered specific physical diagnoses; one included broad diagnostic categories (which showed inconsistent effects across different segments of ED LOS),14 another reported that diagnoses were included in the analysis but provided neither definition nor results 10. Analyses of specific diagnoses or symptoms were more commonly undertaken in condition-specific studies,12 28 29 31 32 34 35 38 but the results may not be relevant to other populations. Other characteristics . Of the seven American studies that considered insurance status, most found longer stays among uninsured patients8 14 17 34 38 or those without private insurance,12 and two also found longer stays among Medicaid patients;14 38 one study of non-admitted patients reported that only Medicare patients had longer LOS 19.…”

“…No study of the general patient population considered specific physical diagnoses; one included broad diagnostic categories (which showed inconsistent effects across different segments of ED LOS),14 another reported that diagnoses were included in the analysis but provided neither definition nor results 10. Analyses of specific diagnoses or symptoms were more commonly undertaken in condition-specific studies,12 28 29 31 32 34 35 38 but the results may not be relevant to other populations.…”

Analyzing Main and Interaction Effects of Length of Stay Determinants in Emergency Departments

“…This study analyzed the main and interaction effects of 4 determinants of ED-LOS (gender, age, mode of arrival, and clinical acuity). Previous studies have used various methodologies to study the main effects of different variables on ED-LOS: chi-square tests 6,7,8,11,16,18,19,25,26,27,28,30,32,37 multiple linear regression, 10,12,13,20,22,23,24,26,36,39 log linear regression, 21 multilevel hierarchical analysis, 9,35,40 autoregression models, 31 simple/multivariate logistic regression models, 11,14,17,24,25,34,43 ANOVA, 5,6,32 and the Cox proportional hazard model. 29,33 However, the literature lacks studies of the interaction effects of 2 or more factors.…”

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…Unfortunately, in a busy hospital, the length of time spent in the ED may be considerably longer. 25 Lack of appropriate triage will lengthen the stay in the ED, especially for an elderly patient who does not appear to require acute care. In addition, the environment is frequently noisy, seemingly chaotic, and often confusing and frightening for the elderly patient and promotes the development of delirium.…”