Predictors of a long length of stay in the emergency department for older people

Abstract

Background Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities. Aims To identify predictors of a long ED length of stay (LLoS) for patients ≥65 years old. Methods Linked hospital information systems data from a large, public Australian ED were analysed in this retrospective cohort study. LLoS was defined as the 75th percentile (617 min). Multivariate regression identified LLoS predictors for admissions and discharges separately. Results Of 16 791 ED presentations made by older people, 4192 experienced a LLoS; 55% were admitted. Increasing age was associated with an increasing ED LoS. Factors most predictive of LLoS for both admitted and discharged patients included: investigations (both pathology and imaging), less urgent Australasian triage scale categories and after‐hours arrival. Ambulance arrival did not increase the risk of a LLoS for patients eventually admitted, but conferred nearly a twofold increased risk for a LLoS for discharged older persons (adjusted odds ratios = 1.9; 95% confidence interval 1.5–2.4). Conclusions This study assists clinicians and decision‐makers to identify reasons why older persons have a LLoS, whether admitted or discharged. Interventions to streamline care for older patients arriving after‐hours and who require imaging and pathology are required. LoS targets should consider age distribution. The use of ED LoS as a quality of care indicator should be assessed for admissions and discharges, separately.

Predictors of prolonged adult hospitalization in the tertiary care hospital emergency department of Saudi Arabia ‎

“…Older age is another factor that is associated with increasing ED LOS in different countries [29][30][31]. Our results also indicate the greater clinical acuity and complexity of older patients, and our findings are concordant with other studies [32]. This finding can be explained that older adults have lesser immunity and multimorbidity; therefore, they take more time to recover or become stable before being shifted to the next level of care or discharged from the hospital.…”

“…Another explanation for this finding might be related to problems in communication, with more time being required to obtain a complete history and perform the physical examination among older patients when compared to younger patients [3]. Another explanation might be the effect of more complex diseases existing among elders as confirmed by other studies [3,32,36,37].…”

Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study

“…Older patients in our study placed a high value on the amount of time they spent waiting in the ED, which is similar to previous studies (10,13,(24)(25)(26). Patients who waited more than 24 h were significantly more likely to report poor ED experiences compared to those who waited less than 6 h. These findings were reflected in the comments, where many older patients expressed concerns over the length of time they spent waiting in the ED and for admission to a ward.…”

Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea

“…ED length of stay (EDLOS), defined as the time interval from when a patient arrives at the ED until the patient leaves the ED, is a widely adopted performance indicator in studies evaluating ED processes [ 13 , 14 ]. Prolonged EDLOS is associated with inefficient ED organization, untimely care, and poor adherence to clinical guidelines [ 15 – 20 ]. EDLOS has also been used as a proxy for ED overcrowding and boarding, which are potential threats to patient safety [ 21 , 22 ].…”