Predictors of patient length of stay in 9 emergency departments

Wiler, Jennifer L.; Handel, Daniel A.; Ginde, Adit A.; Aronsky, Dominik; Genes, Nicholas; Hackman, Jeffrey L.; Hilton, John; Hwang, Ula; Kamali, Michael; Pines, Jesse M.; Powell, Emilie S.; Sattarian, M.; Fu, Rongwei

doi:10.1016/j.ajem.2012.03.028

Cited by 49 publications

(34 citation statements)

References 24 publications

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Section: Discussionsupporting

confidence: 94%

“…Older age and offload times exceeding 30 min were also strong predictors of an ED LOS >4 h, with all having an OR greater than 1.5. This is consistent with other research from the USA 20 and France. 21 Admission to hospital and subsequent time to make this decision could be considered a possible modifiable component, and given it had the largest OR (five times that of those with ED LOS <4 h), it warrants further exploration.…”

Section: Predictors Of Long Emergency Department Length Of Stay (>4 Hsupporting

confidence: 94%

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Improved outcomes for emergency department patients whose ambulance off‐stretcher time is not delayed

Crilly

Keijzers

Tippett

et al. 2015

Emerg Medicine Australasia

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ObjectiveTo describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients.MethodsA retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007–2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h.ResultsOf the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT <30 min had better outcomes for: time to triage; ambulance time at hospital; time to see healthcare professional; proportion seen within recommended triage time frame; and ED LOS for both admitted and non-admitted patients. In-hospital mortality did not differ. Strong predictors of an ED LOS >4 h included: hospital admission, older age, triage category, and offload delay >30 min.ConclusionPatients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful.

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Section: Discussionsupporting

confidence: 94%

Section: Predictors Of Long Emergency Department Length Of Stay (>4 Hsupporting

confidence: 94%

Improved outcomes for emergency department patients whose ambulance off‐stretcher time is not delayed

Crilly

Keijzers

Tippett

et al. 2015

Emerg Medicine Australasia

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“…The National Hospital Ambulatory Medical Care Survey indicated that patient volume in EDs in the U.S. is highest in the evening and on Mondays, Tuesdays, and Sundays than on other days of the week [16]. Additionally, the percentage of admissions from the ED on weekdays was higher than that on weekends [24]. Thus, ED crowding is likely severe on Monday and Tuesday evenings, with a high percentage of admissions from ED, and on Sundays, with a low percentage of admissions.…”

Section: Discussionmentioning

confidence: 99%

Adding More Junior Residents May Worsen Emergency Department Crowding

2014

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BackgroundAlthough increasing staff numbers during shifts when emergency department (ED) crowding is severe can help meet patient demand, it remains unclear how different types of added staff, particularly junior residents, may affect crowding.MethodsTo identify associations between types of staff and ED crowding, we conducted a cross-sectional, single-center study in the ED of a large, teaching hospital in Japan between January and December 2012. Patients who visited the ED during the study period were enrolled. We excluded (1) patients previously scheduled to visit the ED, and (2) neonates transferred from other hospitals. During the study period, 27,970 patients were enrolled. Types of staff analyzed were junior (first and second year) residents, senior (third to fifth year) residents, attending (board-certified) physicians, and nurses. A generalized linear model was applied to length of ED stay for all patients as well as admitted and discharged patients to quantify an association with the additional staff.ResultsIn the model, addition of one attending physician or senior resident was associated with decreased length of ED stay for total patients by 3.88 or 1.64 minutes, respectively (95% CI, 2.20–5.56 and 0.81–2.48 minutes); while additional nursing staff had no association. Surprisingly, however, one additional junior resident was associated with prolonged length of ED stay for total patients by 0.97 minutes (95% CI 0.37–1.57 minutes) and for discharged patients by 1.01 minutes (95% CI 0.45–1.59 minutes).ConclusionStaffing adjustments aimed at alleviating ED crowding should focus on adding more senior staff during peak-volume shifts.

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“…Hal ini memiliki arti bahwa ketika rasio perawat dengan pasien per shift semakin besar maka nilai waktu tunggu pasien setelah keputusan rawat inap diputuskan akan semakin kecil, begitu pula sebaliknya apabila nilai rasio perawat dengan pasien per shift semakin kecil maka nilai waktu tunggu pasien setelah keputusan rawat inap diputuskan akan semakin besar atau memanjang. Artikel jurnal yang dijelaskan oleh Wiler et al ( 2012) dalam penelitiannya menjelaskan juga bagaimana rasio perawat dengan pasien setiap shift menjadi hal yang dapat mempengaruhi lama waktu pelayanan dan beban kerja perawat juga meningkat. Hasil ini sesuai dengan artikel jurnal yang dipublikasikan oleh Zarea (2014) di iran menyebutkan bahwa 78,2% perawat tidak puas dengan kinerja diakibatkan jumlah beban kerja yang meningkat, keamanan dan salary.…”

Section: Pembahasanunclassified

ANALYSIS OF FACTORS ASSOCIATED WITH BOARDING TIME IN YELLOW ZONE OF EMERGENCY DEPARTMENT AT dr.ISKAK TULUNGAGUNG HOSPITAL

Deviantony¹,

Ahsan

Setyoadi

2017

NLJ

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ABSTRAKKunjungan pasien di instalasi gawat darurat (IGD) terus bertambah tiap tahunnya. Peningkatan jumlah kunjungan rumah sakit berbanding lurus dengan peningkatan jumlah pasien yang masuk ke ruang kegawatdaruratan. Jumlah pasien yang meningkat mengakibatkan adanya penumpukan pasien di IGD terutama di zona kuning dan menyebabkan waktu tunggu setelah keputusan rawat inap diputuskan semakin lama. Tujuan penelitian adalah melakukan analisis permasalahan terkait variabel yang memiliki keterikatan dengan waktu tunggu pasien setelah keputusan rawat inap diputuskan di zona kuning instalasi gawat darurat RSUD dr. Iskak Tulungagung. Metode penelitian adalah observasional analitik dengan pendekatan cross sectional. Jumlah sampel 78 responden. Teknik sampling menggunakan non probability sampling. Uji Pearson dan uji Spearman untuk mengetahui hubungan antar variabel dan uji multivariat regresi linier untuk mengetahui faktor yang paling dominan dalam memengaruhi waktu tunggu pasien setelah keputusan rawat inap dibuat. Hasil uji bivariat menunjukkan ada hubungan waktu tunggu pasien setelah keputusan rawat inap dengan waktu persiapan ruangan (p=0,000), hasil uji lab (p=0,000), waktu diagnostik (p=0,000), dan perbandingan perawat dengan pasien (p=0,000). Waktu tunggu pasien tidak ada hubungan dengan waktu kedatangan (p=0,263) dan kepemilikan asuransi (p=0,980). Analisis multivariat dengan regresi linier diperoleh nilai konstanta 681,212, nilai perbandingan perawat dengan pasien (p=0,000; B=-861,011), nilai waktu pemindahan pasien (p=0,000; B=0,620) dan waktu diagnostik (p=0,022; B=2,636) Implikasi penelitian adalah didapatkan konstanta berhubungan dengan boarding time yang mampu memperpendek waktu tunggu pasien setelah keputusan rawat inap dibuat. Saran yang diberikan adalah adanya waktu standar yang bisa dicapai untuk mengurangi waktu boarding pasien. ABSTRACT Patient's visits in the emergency room (ER) increase in number in

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Predictors of patient length of stay in 9 emergency departments

Cited by 49 publications

References 24 publications

Improved outcomes for emergency department patients whose ambulance off‐stretcher time is not delayed

Improved outcomes for emergency department patients whose ambulance off‐stretcher time is not delayed

Adding More Junior Residents May Worsen Emergency Department Crowding

ANALYSIS OF FACTORS ASSOCIATED WITH BOARDING TIME IN YELLOW ZONE OF EMERGENCY DEPARTMENT AT dr.ISKAK TULUNGAGUNG HOSPITAL

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