Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients – A Retrospective Cohort Study

Steffie H. A. Brouns; Patricia M. Stassen; Suze L. E. Lambooij; Jeanne Dieleman; Irene T. P. Vanderfeesten; Harm R. Haak

doi:10.1371/journal.pone.0135066

Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

10.22514/sv.2021.029 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Occupancy Rate ◽

Number Of Patients ◽

Ed Overcrowding

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

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Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: a nationwide retrospective cohort study

BMC Geriatrics ◽

10.1186/1471-2318-15-2 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 14

Author(s):

Carlos A Alvarez ◽

Eric M Mortensen ◽

Una E Makris ◽

Dan R Berlowitz ◽

Laurel A Copeland ◽

...

Keyword(s):

Skeletal Muscle ◽

Emergency Department ◽

Cohort Study ◽

Elderly Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Emergency Department Visits

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Return visits to the pediatric emergency department: A multicentre retrospective cohort study

CJEM ◽

10.1017/cem.2017.40 ◽

2017 ◽

Vol 20 (4) ◽

pp. 578-585 ◽

Cited By ~ 2

Author(s):

Colin B. Meyer-Macaulay ◽

Mimi Truong ◽

Garth D. Meckler ◽

Quynh H. Doan

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Emergency Departments ◽

Retrospective Cohort ◽

Significant Proportion ◽

Pediatric Emergency ◽

Index Visit ◽

Return Visits

AbstractObjectiveReturn visits to the emergency department (RTED) for the same clinical complaint occur in 2.7% to 8.1% of children presenting to pediatric emergency departments (PEDs). Most studies examining RTEDs have focused solely on PEDs and do not capture children returning to other local emergency departments (EDs). Our objective was to measure the frequency and characterize the directional pattern of RTED to any of 18 EDs serving a large geographic area for children initially evaluated at a PED.MethodsWe conducted a retrospective cohort study of all visits to a referral centre PED between August 2012 and August 2013. We compared demographic variables between children with and without an RTED, measures of flow and disposition outcomes between the initial (index) visit and RTED, and between RTED to the original PED versus to other EDs in the community.ResultsAmong all PED visits, 7.6% had an RTED within 7 days, of which 13% were to a facility other than the original PED. Children with an RTED had higher acuity and longer length of stay on their index visit. They were also more likely to be admitted on a subsequent visit than the overall PED population. RTED to the original PED had a longer waiting time (WT), length of stay, and more frequently resulted in hospitalization than RTED to a general ED.ConclusionsA significant proportion of RTED occur at a site other than where the original ED visit occurred. Examining RTED to and from only PEDs underestimates its burden on emergency health services.

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Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy

BMC Health Services Research ◽

10.1186/s12913-020-05472-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Andrea Strada ◽

Niccolò Bolognesi ◽

Lamberto Manzoli ◽

Giorgia Valpiani ◽

Chiara Morotti ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

University Hospital

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Impact of patient isolation on emergency department length of stay: A retrospective cohort study using the Registry for Emergency Care

Emergency Medicine Australasia ◽

10.1111/1742-6723.13607 ◽

2020 ◽

Vol 32 (6) ◽

pp. 1034-1039

Author(s):

Gerard M O'Reilly ◽

Rob D Mitchell ◽

Biswadev Mitra ◽

Michael P Noonan ◽

Ryan Hiller ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Emergency Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Patient Isolation

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Faculty Opinions recommendation of Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735437520.793559102 ◽

2019 ◽

Author(s):

Aryeh Shander

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Blood Cell ◽

Haemoglobin Level ◽

Red Blood Cell ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Red Blood Cell Transfusion

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Clinical characteristics and factors related to antibiotic-associated diarrhea in elderly patients with pneumonia: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02267-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoko Takedani ◽

Tsukasa Nakamura ◽

Noriko Fukiwake ◽

Toshihiro Imada ◽

Junji Mashino ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Elderly Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Tertiary Care ◽

Multivariate Logistic Regression Model ◽

Care Hospital ◽

Antibiotic Associated Diarrhea ◽

Elderly Inpatients

Abstract Background Antibiotic-associated diarrhea (AAD) is a common problem among elderly inpatients because many elderly patients are admitted for pneumonia or other conditions that necessitate antibiotic treatment. In the super aging population, more patients are suffering from pneumonia than before, but the incidence or risk factors for AAD among many elderly patients have not been well scrutinized. Methods We conducted a retrospective cohort study of elderly patients diagnosed with pneumonia from April 2014 to March 2019 who were admitted to the Department of General Medicine of a Tertiary Care Hospital in Japan. Patients (≥ 65 years of age) who were diagnosed with bacterial pneumonia or aspiration pneumonia and treated with antibiotics were included. We defined AAD by diarrhea with more than three loose or watery stools per day and included patients who had these symptoms for either one day or two or more consecutive days. We also assessed the length of hospital stay and in-hospital mortality. The potential risk factors for AAD included age, sex, body weight, body mass index, smoking, alcohol, activities of daily living (ADL),　comorbidities, vital signs, laboratories, the severity of pneumonia, antibiotic and other medication use. Results There were 1,067 patients, the mean age was 83 years, and men accounted for 59 %. β-Lactamase inhibitors were frequently prescribed antibiotics in 703 patients (66 %), and proton pump inhibitors (PPIs) were also commonly administered (48 %). AAD developed in 322 patients (30 %). The multivariate logistic regression model showed that β-lactamase inhibitors (OR 1.43, 95 % CI 1.05–1.95) and PPIs (OR 1.37, 95 % CI 1.03–1.83) were associated with AAD as well as age (OR 1.03 per year, 95 % CI 1.01–1.05). Conclusions AAD was common among elderly inpatients with pneumonia, and β-lactamase inhibitors and PPIs were associated with AAD. Strict use of such medication should be considered to decrease the risk of AAD.

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