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 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

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 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 Excess short-term mortality in noncritical patients with atrial fibrillation presenting to the emergency department

2021 ◽  
Author(s):  
Jan Niederdöckl ◽  
Michael Schwameis ◽  
Harald Herkner ◽  
Hans Domanovits
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Critically Ill ◽  
Mortality Rates ◽  
Mortality Data ◽  
Consecutive Series ◽  
Short Term ◽  
Short Term Mortality ◽  
Critically Ill Adults ◽  
Austrian Population

Summary Background Mortality data of non-critically ill patients presenting with symptomatic atrial fibrillation to an emergency department are scarce. We aimed to analyze the short-term mortality of these patients compared with that of the general Austrian population. Design/methods This study analyzed a consecutive series of non-critically ill adults presenting to the emergency department at the Medical University of Vienna between 2012 and 2016 with complaints related to atrial fibrillation. The study outcome was mortality during the observation period. Age-specific and sex-specific mortality rates per 100 person-years were calculated and compared with the mortality rates of the Austrian population during the same period. Results In total, 1754 patients with atrial fibrillation (43.1% female) were included in the study. During a median follow-up of 25 months, 248 of these patients died. Observed mortality rates were 7.8 per 100 person-years for females (95% confidence interval, CI 6.6–9.5) and 5.9 per 100 person-years for males (95% CI 5.0–7.1). Age-adjusted and sex-adjusted mortality rates were 2.8 (95% CI 2.3–3.3) and 2.7 (95% CI 2.2–3.2) per 100 person-years, respectively. Mortality rates for the Austrian population were 1.1 per 100 person-years for both females and males. Corresponding standardized mortality ratios were 2.5 for females (95% CI 2.1–3.0) and 2.4 for males (95% CI 2.0–2.9). Conclusion The short-term mortality of patients with symptomatic atrial fibrillation presenting to the emergency department was substantially higher compared with the general Austrian population.

scholarly journals Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

2021 ◽  
Author(s):  
Aiham Qdaisat ◽  
Sai-Ching Yeung ◽  
Cristhiam M Rojas Hernandez ◽  
Pavani Samudrala ◽  
Mona Kamal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Platelet Count ◽  
Cancer Patients ◽  
Intracranial Hemorrhage ◽  
Statistical Significance ◽  
Mortality Rates ◽  
Short Term ◽  
Short Term Mortality ◽  
Low Platelet Count

Abstract Introduction: Intracranial hemorrhage is a devastating complication of cancer and its treatment.Objective: To evaluate the characteristic, risk factors and clinical outcomes in cancer patients with intracranial hemorrhage presenting to the emergency department. Methods: We collected a decade of retrospective data on all patients with the diagnosis of ICH who visited The University of Texas MD Anderson Cancer Center emergency department. Logistic regression analyses were used to determine the association between clinical variables and various outcomes.Results: 704 confirmed acute ICH cases were identified. Of these, 576 (81.8%) were spontaneous. In-hospital, 7-day, and 30-day mortality rates were 15.1%, 11.4%, and 25.6%, respectively. Hypertension was most predictive of prolonged hospital stay ( [OR]=4.77, 95% [CI]=1.30-22.70, P=0.045) and intensive care unit admission (OR=1.52, 95% CI=1.09-2.12, P=0.013). Low platelet count was associated with both in-hospital mortality (OR=0.96, 95% CI=0.94-0.99, P=0.008) and 30-day mortality (OR=0.98, 95% CI=0.96-1.00, P=0.016). Radiologic findings especially herniation and hydrocephalus, were strong predictors of short-term mortality. Patients with intratumor bleeding had substantially lower short-term mortality rates, but this did not reach statistical significance.Conclusions: Intracranial hemorrhage remains an uncommon complication in cancer patients. The risk factors most helpful in predicting outcomes were hypertension, low platelet count, and hydrocephalus or herniation on imaging.

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erica M. Jones ◽  
Amelia K. Boehme ◽  
Aimee Aysenne ◽  
Tiffany Chang ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Adverse Outcomes ◽  
Stroke Patients ◽  
Significant Independent Predictor ◽  
Prolonged Length ◽  
Stroke Center ◽  
Shift Change

Objectives. Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods. Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results. Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death. Conclusions. Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.

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