Factors associated with prolonged length of stay of non-trauma patients in the emergency department

Abstract

Background : Recently found that emergency department (ED) is overcrowding. There is no definition in Thailand hospital to describe prolonged length of stay in emergency department. Therefore, understand which factors impact ED patients to develop service and reduce congestion. Objective : To determine the factors associated with prolonged length of stay for improving access to ED care in a tertiary government emergency medical training hospital in Thailand. Methods : A retrospective cohort study using routinely collected data involving patients presenting acutely to the ED of non-trauma patients over a 6-month period in March-August 2015. Reviewed the records of 2,079 consecutive patients. Key data were recorded, including Patient characteristics, Types of health insurance, Times of presenting to emergency room, Days of week (weekday/weekend), Triage categories, Underlying disease and disease complexity using the Charlson comorbidity index (CCI) and Diagnosis categories. Results : Univariate analysis revealed several factors that may affect ED length of stay. Age (in 10 years), Type of health insurance, Times of presenting to ER, Weekend, Triage categories and CCI were all identified as potentially important (p <0.2) and subsequently entered into the multivariable cox regression model. The multivariate model identified Age, Weekend, Underlying disease and disease complexity and Time of day as all significant predictors of ED length of stay. For every 10 years older a patient is, the chance of discharge is 10% less (HR, 0.90; 95% CI, 0.88-0.92, p < 0.001). Those admitted on the weekend had 1.18 times for chance of discharge (at any given time) compared to those presenting on weekday (HR,1.18; 95% CI, 1.07-1.29, p <0.001), and those in both the evening and night shift had a lower chance of discharge compared to those in day shift (evening shift HR,0.83; 95% CI, 0.75-0.92,p<0.001 ; night shift HR,0.89; 95% CI,0.78-0.99, p<0.2) Finally, patients with CCI ≥ 3 had a 9% less chance of discharge, compare to patients with CCI 0-2 (HR 0.91; 95% CI, 0.88-0.94,p <0.001). Conclusions : A majority of patients spent too long in the emergency room and almost all factors in this study were shown to be associated with prolonged length of stay in the ED. However, the downstream effect of extended ED stay on patient safety and mortality needs further research.