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Analysis of factors influencing length of stay in the emergency department

Published online by Cambridge University Press:  21 May 2015

Philip Yoon ,
Ivan Steiner  and
Gilles Reinhardt
Philip Yoon*
Affiliation:
Division of Emergency Medicine and Department of Family Medicine, University of Alberta, Edmonton, Alta
Ivan Steiner
Affiliation:
Division of Emergency Medicine and Department of Family Medicine, University of Alberta, Edmonton, Alta
Gilles Reinhardt
Affiliation:
Department of Management, College of Commerce, DePaul University, Chicago, Ill.
*
Division of Emergency Medicine, University of Alberta Hospital, 8440 — 112 St., Edmonton AB T6G 2B7; 780 407-7047, fax 780 407-3314;yoonp@ualberta.ca

Abstract

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Objectives:

Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels.

Methods:

In this retrospective review, conducted at a large urban tertiary care teaching hospital and trauma centre, investigators reviewed the records of 1047 consecutive patients treated during a continuous 7-day period in January 1999. Key data were recorded, including patient characteristics, ED process times, tests performed, consultations and overall ED LOS. Of the 1047 patient records, 153 (14.6%) were excluded from detailed analysis because of incomplete documentation. Process times were determined and stratified by triage level, using the Canadian Emergency Department Triage and Acuity Scale (CTAS). Multiple linear regression analysis was performed to determine which factors were most strongly associated with prolonged LOS.

Results:

Patients in intermediate triage Levels III and IV generally had the longest waiting times to nurse and physician assessment, and the longest ED lengths of stay. CTAS triage levels predicted laboratory and imaging utilization as well as consultation rate. The use of diagnostic imaging and laboratory tests was associated with longer LOS, varying with the specific tests ordered. Specialty consultation was also associated with prolonged LOS, and this effect was highly variable depending on the service consulted.

Conclusions:

Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.

Keywords

emergency departmentlength of stayCanadian Emergency Department Triage and Acuity ScaleCTAS
Type
ED Administration • L’administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 3 , May 2003 , pp. 155 - 161
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

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