scholarly journals The association between length of stay in the emergency department and short-term mortality

2021 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carl Carlsson ◽  
Ulf Ekelund ◽  
Per Wändell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
University Hospital ◽  
University Hospitals ◽  
Short Term ◽  
Priority Level ◽  
Higher Ed ◽  
Short Term Mortality ◽  
Priority Levels ◽  
Clinical Urgency

AbstractThe detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2–4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20–1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.

scholarly journals The association between length of stay in the emergency department and short term mortality

2020 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carlsson ◽  
Ulf Ekelund ◽  
Olle Melander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Care ◽  
University Hospital ◽  
University Hospitals ◽  
Short Term ◽  
Priority Group ◽  
Group 4 ◽  
Short Term Mortality ◽  
Clinical Urgency

Abstract Background: The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short term mortality in patients admitted to the EDs of two large University hospitals in Sweden. Methods: All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n=639 385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7 and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Results: We observed that prolonged ED-LOS was associated with increased mortality for patients with lowest triage priority (risk estimates for 30-day mortality were OR 1.49 (CI 95% 1.20-1.85) for patients with triage priority group 4 and the highest quintile of ED-LOS. No such association was observed in patients with the highest triage priority group and in patients admitted to in-hospital care. Conclusion : Our data suggest that increased ED-LOS could be associated with slightly increased short term mortality in patients with lower clinical urgency and dismissed from the ED but that this does not include patients admitted to in-hospital care.

scholarly journals The association between length of stay in the emergency department and short term mortality

2019 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carlsson ◽  
Ulf Ekelund ◽  
Olle Melander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Care ◽  
Mortality Rates ◽  
University Hospital ◽  
Short Term ◽  
Opposite Pattern ◽  
Prolonged Length ◽  
Short Term Mortality ◽  
Clinical Urgency

Abstract Background: Prolonged length of stay at the emergency department (ED-LOS) has been associated with increased mortality and hospital stay. The aim of this study was to investigate the association between ED-LOS and 7- and 30-days mortality in patients triaged according to Rapid Emergency Triage and Treatment System – Adult (RETTS-A), the most common used triage tool in Sweden. Methods: All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n=639 385) were included. Logistic regression analysis was used to determine association between prolonged ED-LOS and 7 and 30-days mortality rates. All patients were triaged according to the RETTS-A and subsequently separated into five quintiles of ED-LOS. Results : In patients triaged with the highest medical urgency, longer ED-LOS was associated with a lower risk for 7-days mortality, for triage priority 1: OR 0.94 (CI 95% 0.92-0.96) compared to OR 1.03 (CI 95% 0.99-1.07) for triage priority 4, and for 30-days mortality: OR 0.97 (CI 95% 0.96-0.99) OR for triage priority 1 compared to 1.03 (CI 95% 1.01-1.05) for triage priority 4. In contrast, the opposite pattern appeared evident in the 3 other triage groups, where a longer ED-LOS was generally associated with an increased mortality risk. Pro-longed ED-LOS in patients admitted to in-hospital care was associated with lower 30- and 7-days mortality independently of triage priority whereas the opposite was observed for patients not admitted to in-hospital care. Conclusion: Prolonged ED-LOS was associated with increased short term mortality in patients with lower clinical urgency and in patients not admitted to in-hospital care.

scholarly journals A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department

2018 ◽  
pp. emermed-2016-206382 ◽  
Author(s):  
Anne Kristine Servais Iversen ◽  
Michael Kristensen ◽  
Rebecca Monett Østervig ◽  
Lars Køber ◽  
György Sölétormos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Assessment ◽  
University Hospital ◽  
Short Term ◽  
Primary Analysis ◽  
Prediction Of Mortality ◽  
Short Term Mortality ◽  
Yellow Orange ◽  
Minor Injuries ◽  
Triage Level

ObjectiveTo compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).MethodsThe investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.ResultsA total of 6383 patient visits were included. DEPT was performed for 6290 (98.5%) and Eyeball triage for 6382 (~100%) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95% CI 0.4 to 1.9) for DEPT compared with 4.2 (95% CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95% CI 1.1 to 4.4) and 17.1 (95% CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95% CI 12.3 to 77.4) for DEPT and 128.7 (95% CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95% CI 1.2 to 2.4) for DEPT and 2.4 (95% CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95% CI 1.8 to 3.6) for DEPT and 7.6 (95% CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95% CI 10.4 to 35.2) for DEPT and 27.1 (95% CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).ConclusionAgreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.

scholarly journals Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Anders Kasper Bruun Kristensen ◽  
Jon Gitz Holler ◽  
Søren Mikkelsen ◽  
Jesper Hallas ◽  
Annmarie Lassen
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Prehospital Setting ◽  
Short Term ◽  
Short Term Mortality

scholarly journals Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

2020 ◽  
Author(s):  
Andrea Strada ◽  
Niccolò Bolognesi ◽  
Lamberto Manzoli ◽  
Giorgia Valpiani ◽  
Chiara Morotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Abdominal Pain ◽  
Chest Pain ◽  
Length Of Stay ◽  
Diagnostic Algorithm ◽  
University Hospital ◽  
Blood Tests ◽  
Traumatic Bleeding ◽  
Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

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