Type of facility influences lengths of stay of children presenting to high volume emergency departments

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

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Effect of an Intervention to Improve Team Coordination on Patients Who are Likely to be Discharged by General Internal Medicine

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v10i1.21 ◽

1970 ◽

Vol 10 (1) ◽

Author(s):

Lina Pham BA ◽

Teri Arany ◽

William Coke MD ◽

Vivian Lo ◽

Robert C. Wu MD

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Length Of Stay ◽

General Internal Medicine ◽

Discharge Planning ◽

Teaching Hospitals ◽

Post Discharge ◽

General Internal ◽

Effective Discharge ◽

The Impact

Effective discharge planning is important to ensuring a high quality of patient care and operational efficiency. The general internal medicine (GIM) environment is very complex and fluid, with multiple health professions providing care for patients. This makes coordination of discharges difficult, even with structured daily interprofessional rounds.The purpose of this case-control study was to evaluate a discharge notification form that predicts next-day discharges. The main measures of the study, which took place in GIM wards at two academic teaching hospitals, were the completion and accuracy of the discharge forms, length of stay, discharge times, post-discharge admissions, and emergency department visits.Seventy-six of 200 patients studied had information completed on the discharge notification form. The overall effect appeared to move discharges earlier in the day, while having no effect on length of stay.Patients whose information was completed on the discharge notification form were less likely to have an emergency department visit within 30 days post-discharge.The use of a discharge notification form appears to move discharges earlier in the day, without increasing length of stay. Further refinement and evaluation is necessary to increase usage and assess the impact onoutcomes of care.

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LO54: A descriptive analysis of ED length of stay of admitted patients ‘boarded’ in the emergency department

CJEM ◽

10.1017/cem.2017.116 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S46

Author(s):

L. Salehi ◽

P. Phalpher ◽

R. Valani

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Descriptive Analysis ◽

High Volume ◽

Increased Risk ◽

Significant Difference ◽

Ed Overcrowding ◽

Day Of The Week ◽

The Mean ◽

The Impact

Introduction: Previous studies have shown a link between Emergency Department (ED) overcrowding and worse clinical outcomes, increased risk of in-hospital mortality, higher costs, and longer times to treatment. Prolonged ED Length of Stay (LoS) of admitted patients awaiting a bed on in-patient units has been identified as a major driver of ED overcrowding. The purpose of this study is to provide a descriptive analysis of ED LoS among admitted patients, and determine the impact of prolonged ED LoS on total hospital in-patient length of stay (IP LoS). Methods: We conducted a single-site retrospective study for the period between January 1-December 31, 2015 at a very high volume community hospital. All patients aged ≥18 years admitted from the ED to acute in-patient Medicine units were identified. We carried out overall descriptive analysis (including analysis of day-of-the-week variability) on ED LoS. The mean total IP LoS for those patients with ED LoS<12 hours, 12-24 hours, and ≥24 hours were calculated and analyzed using ANOVA and Tukey HSD tests. Results: A total of 6,961 individuals were admitted to the medical units over the 12-month period. The median and mean ED LoS for admitted patients were 22.9 hrs (IQR: 13.9 hrs- 33.1 hrs) and 25.6 hrs respectively. Using ANOVA, there was a statistically significant difference in means of ED LoS as a function of the day of the week (p<0.0001), with Mondays having the highest mean ED LoS (27.6 hrs), and Fridays having the lowest (23.1 hrs). The mean IP LoS for those with ED LoS<12 hours, 12-24 hours, and ≥24 hours, were 6.8 days, 6.9 days, and 8.5 days respectively, with a statistically significant difference between group means (p<0.0001). Multiple pairwise comparisons of group means showed a statistically significant (p<0.05) difference between mean IP LOS of those with an EDLOS≥24 hours and those with an EDLOS<24 hours. Conclusion: Preliminary results indicate that ED LoS≥24 hours among admitted patients was associated with an increase in total IP LoS.*In the next 1-2 months, we intend to explore the role of other independent variables (age, sex, comorbidity, isolation status, and telemetry) on total ED LoS, and its association with IP LoS.

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Emergency Department Crowding is Harder to Solve: The Impact of COVID-19 of Longer Length of Stay

10.21203/rs.3.rs-1089883/v1 ◽

2021 ◽

Author(s):

Fengbao Guo ◽

Yan Qin ◽

Hailong Fu ◽

Feng Xu

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Emergency Department Crowding ◽

Wilcoxon Rank Sum Test ◽

Significant Difference ◽

Chi Squared ◽

The Difference ◽

Emergency Neurology ◽

The Impact ◽

Case Data

Abstract Objectives To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the emergency department (ED). Methods A retrospective review of case data of patients in the ED during the early stages of the COVID-19 pandemic in the First Affiliated Hospital of Soochow University (January 15, 2020– January 14, 2021) was performed and compared with that during the pre-COVID-19 period (January 15, 2019 – January 14, 2020). Patient information including age, sex, length of stay, and death was collected. Wilcoxon Rank sum test was utilized to compare the difference in LOS between the two cohorts. Chi-Squared test was utilized to analyze the prognosis of patients. The LOS and prognosis in different departments (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed. Results Of the total 8278 patients, 4159 (50.24%) were ordered in the COVID-19 pandemic group and 4119 (49.76%) were ordered in the pre-COVID-19 group. The length of stay prolongs significantly in the COVID-19 group compared with that in the pre-COVID-19 group(13h vs 9.8h; p < 0.001). There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%; p=0.341). Conclusion The COVID-19 pandemic was associated with a significant increase in the length of stay, which may lead to emergency department crowding. And the influence of the COVID-19 pandemic on patients in different emergency departments is different. There is no significant impact on the LOS of emergency neuropathy. Across departments, COVID-19 didn’t have a significant impact on the prognosis of ED patients.

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Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

Journal of Patient Experience ◽

10.1177/23743735211011404 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110114

Author(s):

Andrew Nyce ◽

Snehal Gandhi ◽

Brian Freeze ◽

Joshua Bosire ◽

Terry Ricca ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Patient Experience ◽

Waiting Times ◽

Hospital Length ◽

Short Length ◽

Hospital Length Of Stay ◽

Patient’S Experience ◽

Discharged Patients ◽

The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

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Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz481 ◽

2019 ◽

Cited By ~ 3

Author(s):

Larissa May ◽

Grant Tatro ◽

Eduard Poltavskiy ◽

Benjamin Mooso ◽

Simson Hon ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Usual Care ◽

Controlled Trial ◽

Antibiotic Use ◽

Respiratory Pathogens ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections ◽

The Impact

Abstract Background Acute upper respiratory tract infections are a common cause of Emergency Department (ED) visits and often result in unnecessary antibiotic treatment. Methods We conducted a randomized clinical trial to evaluate the impact of a rapid, multi-pathogen respiratory panel (RP) test versus usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenza like illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136). Results Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (p=0.0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12% [95% CI -25%, 0.4%]; p=0.06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) versus adults (-9%; post-hoc analysis). There was no difference in antiviral use, length of stay, or disposition. Conclusions Rapid RP testing was associated with a trend towards decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.

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Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

10.21203/rs.3.rs-84330/v3 ◽

2021 ◽

Author(s):

Maria Khan ◽

Uzair Yaqoob ◽

Zair Hassan ◽

Muhammad Muizz Uddin

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Road Traffic ◽

Tertiary Care ◽

Initial Assessment ◽

Care Hospital ◽

Mild Tbi ◽

Epidemiological Characteristics ◽

The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

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Evaluating alcohol intoxication management services: the EDARA mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08240 ◽

2020 ◽

Vol 8 (24) ◽

pp. 1-214 ◽

Cited By ~ 1

Author(s):

Simon C Moore ◽

Davina Allen ◽

Yvette Amos ◽

Joanne Blake ◽

Alan Brennan ◽

...

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Alcohol Intoxication ◽

Ethnographic Study ◽

Acute Alcohol Intoxication ◽

Front Line ◽

Night Time ◽

Number Of Patients ◽

The Impact ◽

Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

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The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients

Medical Care ◽

10.1097/mlr.0000000000001638 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Michael Reaume ◽

Ricardo Batista ◽

Emily Rhodes ◽

Braden Knight ◽

Haris Imsirovic ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Home Care ◽

Emergency Department Visits ◽

Care Recipients ◽

The Impact

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Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

BMC Health Services Research ◽

10.1186/s12913-020-05774-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anqi Chen ◽

Scott Fielding ◽

X. Joan Hu ◽

Patrick McLane ◽

Andrew McRae ◽

...

Keyword(s):

Length Of Stay ◽

Emergency Departments ◽

Patient Flow ◽

Flow Characteristics ◽

Initial Assessment ◽

Cox Models ◽

Lengths Of Stay ◽

Random Samples ◽

High System ◽

And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

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LO21: Consistency of CTAS scores by presenting complaint pre and post eCTAS implementation in 35 emergency departments across Ontario

CJEM ◽

10.1017/cem.2020.77 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S14-S15

Author(s):

S. McLeod ◽

C. Thompson ◽

B. Borgundvaag ◽

L. Thabane ◽

H. Ovens ◽

...

Keyword(s):

Emergency Departments ◽

Improve Patient Safety ◽

Vital Signs ◽

Decision Support Tool ◽

High Volume ◽

Population Based ◽

Primary Objective ◽

Absolute Difference ◽

Altered Level ◽

Support Tool

Introduction: eCTAS is a real time electronic triage decision-support tool designed to improve patient safety and quality of care by standardizing the application of the Canadian Triage and Acuity Scale (CTAS). The tool dynamically calculates a recommended CTAS score based on the presenting complaint, vital signs and selected clinical modifiers. The primary objective was to assess consistency of CTAS score distributions across 35 emergency departments (EDs) by 16 presenting complaints pre and post eCTAS implementation. Methods: This retrospective cohort study used population-based administrative data from January 2016 to December 2018 from all hospital EDs in Ontario that had implemented eCTAS with at least 9 months of data. Following a 3-month stabilization period, we compared data for 6 months post-eCTAS implementation to the same 6-month period the previous year (pre-implementation) to account for potential seasonal variation, patient volume and case-mix. We included triage encounters of adult (≥18 years) patients if they had one of 16 pre-specified high-volume, presenting complaints. A paired-samples t-test was used to determine consistency by estimating the absolute difference in CTAS distribution for each presenting complaint, by each hospital, pre and post eCTAS implementation, compared to the overall average of the 35 EDs. Results: There were 183,231 triage encounters in the pre-eCTAS cohort and 179,983 in the post-eCTAS cohort from 35 EDs across the province. Triage scores were more consistent with the overall average after eCTAS implementation in 6 (37.5%) presenting complaints: chest pain (cardiac features) (p < 0.001), extremity weakness/symptoms of cerebrovascular accident (p < 0.001), fever (p < 0.001), shortness of breath (p < 0.001), syncope (p = 0.02), and hyperglycemia (p = 0.03). Triage consistency was similar pre and post eCTAS implementation for the presenting complaints of altered level of consciousness, anxiety/situational crisis, confusion, depression/suicidal/deliberate self-harm, general weakness, head injury, palpitations, seizure, substance misuse/intoxication or vertigo. Conclusion: A standardized, electronic approach to performing triage assessments increased consistency in CTAS scores across many, but not all, high-volume CEDIS complaints. This does not reflect triage accuracy, as there are no known benchmarks for triage accuracy. Improvements in consistency were greatest for sentinel presenting complaints with a minimum allowable CTAS score.

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