Emergency Department Length of Stay and Its Association with Patient Outcomes

Authors

  • Zahid Ullah Khan
  • Khalil Ullah
  • Abdul Wahab
  • Asif Khan
  • Asif Khan
  • Rustam Khan

DOI:

https://doi.org/10.63682/jns.v13i1.9985

Keywords:

Emergency department, Length of stay, Mortality, ICU admission, Patient outcomes

Abstract

Background: Prolonged emergency department length of stay (ED-LOS) has been linked to poor clinical outcomes as well as is one of the most important measurements of emergency department crowding. This relationship can be made clear to enhance patient safety and efficiency of care.

Objective: The aim of the study was to assess the relationship of ED-LOS and patient outcome, including in-hospital mortality, ICU admission, hospital length of stay, and 7-day ED revisits, in a tertiary care hospital of Peshawar, Pakistan.

Methods: The Emergency Department of Lady Reading Hospital between June 2023 and December 2023 was used to conduct a prospective observational study. Adults ( 18 and above) presenting to the ED were recruited. ED-LOS, demographic information, comorbidities, and triage desegregations were documented. The comparison of outcomes was carried out through descriptive statistics, chi-square tests, and multivariate logistic regression to identify free associations.

Results: The median ED-LOS of 824 patients was 5.6 hours (IQR 3.29.4). Standard ED-LOS in excess of 8 hours was also significantly linked with in-hospital mortality (AOR 4.36), ICU admission (AOR 3.78), and 7-day ED revisits (AOR 2.89) (p < 0.001 all).

Conclusion: Long ED-LOS is an important factor that predisposes poor outcomes. The efficient management of the patient flow, bed management, and identification of the time when care should be escalated can optimize patient safety and decrease avoidable morbidity.
 

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References

[1] Savioli G, Ceresa IF, Gri N, Bavestrello Piccini G, Longhitano Y, Zanza C, Piccioni A, Esposito C, Ricevuti G, Bressan MA. Emergency department overcrowding: understanding the factors to find corresponding solutions. Journal of personalized medicine. 2022 Feb 14;12(2):279.

[2] Pearce S, Marr E, Shannon T, Marchand T, Lang E. Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes. Internal and Emergency Medicine. 2024 Mar;19(2):483-91.

[3] Pearce S, Marchand T, Shannon T, Ganshorn H, Lang E. Emergency department crowding: an overview of reviews describing measures causes, and harms. Internal and Emergency Medicine. 2023 Jun;18(4):1137-58.

[4] Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, Cremonesi P, Canale F, Cristina ML. Overcrowding in emergency department: causes, consequences, and solutions—a narrative review. InHealthcare 2022 Aug 25 (Vol. 10, No. 9, p. 1625). MDPI.

[5] Franklin BJ, Vakili S, Huckman RS, Hosein S, Falk N, Cheng K, Murray M, Harris S, Morris CA, Goralnick E. The inpatient discharge lounge as a potential mechanism to mitigate emergency department boarding and crowding. Annals of Emergency Medicine. 2020 Jun 1;75(6):704-14.

[6] Smalley CM, Simon EL, Meldon SW, Muir MR, Briskin I, Crane S, Delgado F, Borden BL, Fertel BS. The impact of hospital boarding on the emergency department waiting room. JACEP Open. 2020 Oct 1;1(5):1052-9.

[7] Samadbeik M, Staib A, Boyle J, Khanna S, Bosley E, Bodnar D, Lind J, Austin JA, Tanner S, Meshkat Y, de Courten B. Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system. BMC Health Services Research. 2024 Mar 5;24(1):274.

[8] Boulain T, Malet A, Maitre O. Association between long boarding time in the emergency department and hospital mortality: a single-center propensity score-based analysis. Internal and emergency medicine. 2020 Apr;15(3):479-89.

[9] Wessman T, Ärnlöv J, Carlsson AC, Ekelund U, Wändell P, Melander O, Ruge T. The association between length of stay in the emergency department and short-term mortality. Internal and emergency medicine. 2022 Jan;17(1):233-40.

[10] Moon S, Kim T, Park H, Kim H, Shin J, Park YS, Wang G. Effect of emergency physician-operated emergency short-stay ward on emergency department stay length and clinical outcomes: a case-control study. BMC Emergency Medicine. 2023 May 12;23(1):47.

[11] Kim, J. S., Seo, D. W., Kim, Y. J., Jeong, J., Kang, H., Han, K. S., ... & Kim, W. Y. (2020). Prolonged length of stay in the emergency department and increased risk of in-hospital cardiac arrest: a nationwide population-based study in South Korea, 2016–2017. Journal of Clinical Medicine, 9(7), 2284.

[12] Burgess L, Ray‐Barruel G, Kynoch K. Association between emergency department length of stay and patient outcomes: a systematic review. Research in Nursing & Health. 2022 Feb;45(1):59-93.

[13] Jones PG, Mountain D, Forero R. Emergency department crowding measures associations with quality of care: a systematic review. Emergency Medicine Australasia. 2021 Aug;33(4):592-600.

[14] Ramzee AF, El-Menyar A, Asim M, Kanbar A, Ahmed K, Daoud B, Mathradikkal S, Kloub A, Al-Thani H, Rizoli S. The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study. World Journal of Emergency Medicine. 2023;14(2):96.

[15] Rybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, Checkett KA, Rouhani SA, Tenner AG, Geduld H, Reynolds T. Emergency medicine training programs in low-and middle-income countries: a systematic review. Annals of Global Health. 2020 Jun 16;86(1):60.

[16] Werner K, Kak M, Herbst CH, Lin TK. Emergency care in post-conflict settings: a systematic literature review. BMC emergency medicine. 2023 Apr 1;23(1):37.

[17] Jackson M, Cairns T. Care of the critically ill patient. Surgery (oxford). 2021 Jan 1;39(1):29-36.

[18] Liao PH, Chu W, Ho CS. An analysis of waiting time for emergency treatment and optimal allocation of nursing manpower. InHealthcare 2022 Apr 28 (Vol. 10, No. 5, p. 820). MDPI.

[19] Goel NN, Durst MS, Vargas-Torres C, Richardson LD, Mathews KS. Predictors of delayed recognition of critical illness in emergency department patients and its effect on morbidity and mortality. Journal of intensive care medicine. 2022 Jan;37(1):52-9.

[20] Nesbitt J, Mitarai T, Chan GK, Wilson JG, Niknam K, Nudelman MJ, Cinkowski C, Kohn MA. Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients. The American Journal of Emergency Medicine. 2021 Mar 1;41:120-4.

[21] Soltani M, Batt RJ, Bavafa H, Patterson BW. Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ED care use. Manufacturing & Service Operations Management. 2022 Nov;24(6):3079-98..

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Published

2024-05-15

How to Cite

1.
Khan ZU, Ullah K, Wahab A, Khan A, Khan A, Khan R. Emergency Department Length of Stay and Its Association with Patient Outcomes. J Neonatal Surg [Internet]. 2024 May 15 [cited 2026 Feb. 25];13(1):2151-6. Available from: https://jneonatalsurg.com/index.php/jns/article/view/9985

Issue

Vol. 13 (2024): Journal of Neonatal Surgery

Section

Original Article

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