Statistical analysis of factors influencing patient length of stay in emergency departments

Abstract

PurposePatient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.Design/methodology/approachThis study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.FindingsThe findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.Originality/valuePrevious studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

Improving the emergency services using quality improvement project and Donabedian model in a quaternary teaching hospital in South India

“…Factors such as TAT for diagnostics and specialty consultation, triage level and bed availability can significantly impact the average LOS. [12][13][14][15] Through root cause analysis (RCA), internal audits and observations, the current project identified similar factors affecting LOS, along with other reasons such as patient flow, personnel shortage, lack of equipment/diagnostic aids and decisions regarding patient discharge or transfer. The project team addressed these issues by implementing relevant strategies.…”

Factors associated with prolonged emergency department length of stay in a resource-constrained setting

“…A study in the Netherlands concluded that organizational factors, such as more consultations, testing in the ED and lower physician seniority were associated with longer ED LOS [7]. A variety of other studies revealed additional factors affecting ED LOS such as patient ethnicity, the timing of ED presentation, season of ED presentation, old age, insurance status, complexity of patient condition and ED physician treatment style [8,9].…”