scholarly journals Analysis of Factors Affecting the Length of Stay in the Emergency Department for Critically Ill Patients Transferred to Regional Emergency Medical Centers

2022 ◽  
Author(s):  
Hyungbok Lee ◽  
Sangrim Lee ◽  
Hyeoneui Kim
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prediction Models ◽  
Emergency Operation ◽  
Factors Affecting ◽  
Interhospital Transfer ◽  
Triage Level

Abstract BackgroundTransferring an emergency patient to another emergency department (ED) is necessary when she/he is unable to receive necessary treatment from the first visited ED, although the transfer poses potential risks for adverse clinical outcomes and lowering the quality of emergency medical services by overcrowding the transferred ED. This study aimed to understand the factors affecting the ED length of stay (LOS) of critically ill patients and to investigate whether they are receiving prompt treatment through Interhospital Transfer (IHT).MethodsThis study analyzed 968 critically ill patients transferred to the ED of the study site in 2019. Machine learning based prediction models were built to predict the ED LOS dichotomized as greater than 6 hours or less. Explanatory variables in patient characteristics, clinical characteristics, transfer-related characteristics, and ED characteristics were selected through univariate analyses.ResultsAmong the prediction models, the Logistic Regression (AUC 0.85) model showed the highest prediction performance, followed by Random Forest (AUC 0.83) and Naïve Bayes (AUC 0.83). The Logistic Regression model suggested that the need for emergency operation or angiography (OR 3.91, 95% CI=1.65–9.21), the need for Intensive Care Unit (ICU) admission (OR 3.84, 95% CI=2.53–5.83), fewer consultations (OR 3.57, 95% CI=2.84–4.49), a high triage level (OR 2.27, 95% CI=1.43–3.59), and fewer diagnoses (OR 1.32, 95% CI=1.09–1.61) coincided with a higher likelihood of 6-hour-or-less stays in the ED. Furthermore, an interhospital transfer handoff led to significantly shorter ED LOS among the patients who needed emergency operation or angiography, or ICU admission, or had a high triage level.ConclusionsThe results of this study suggest that patients prioritized in emergency treatment receive prompt intervention and leave the ED in time. Also, having a proper interhospital transfer handoff before IHT is crucial to provide efficient care and avoid unnecessarily longer stay in ED.

scholarly journals Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Amanda S. Newton ◽  
Sachin Rathee ◽  
Simran Grewal ◽  
Nadia Dow ◽  
Rhonda J. Rosychuk
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Length Of Stay ◽  
Wait Time ◽  
Factors Affecting ◽  
Hazard Ratios ◽  
Laboratory Investigations ◽  
Logistic Regressions ◽  
Pediatric Mental Health ◽  
Triage Level

Objective. This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS).Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR) with 95% confidence intervals (CIs).Results. Sex (male:HR=1.48, 95%CI=1.20–1.84), ED type (pediatric ED:HR=5.91, 95%CI=4.16–8.39), and triage level (Canadian Triage and Acuity Scale (CTAS) 2:HR=3.62, 95%CI=2.24–5.85) were statistically significant predictors of wait time. ED type (pediatric ED:HR=1.71, 95%CI=1.18–2.46), triage level (CTAS 5:HR=2.00, 95%CI=1.15–3.48), number of consultations (HR=0.46, 95%CI=0.31–0.69), and number of laboratory investigations (HR=0.75, 95%CI=0.66–0.85) predicted LOS.Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.

scholarly journals Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality

2021 ◽  
Vol 25 (11) ◽  
pp. 1221-1225
Author(s):  
Ankur Verma ◽  
Amit Vishen ◽  
Meghna Haldar ◽  
Sanjay Jaiswal ◽  
Rinkey Ahuja ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Intensive care unit admission protocol controlled by intensivists can reduce transfer delays from the emergency department in critically ill patients

2018 ◽  
Vol 26 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Ji Eun Kim ◽  
Seul Lee ◽  
Jinwoo Jeong ◽  
Dong Hyun Lee ◽  
Jin-Heon Jeong
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Before And After

Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher in-hospital mortality and increased hospital length of stay. Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients. Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention. Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3–1665.3) min to 392.0 (279.3–686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0–11.8) days to 5.0 (3.0–10.0) days (p = 0.015). Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

scholarly journals Emergency Department Length of Stay for Critically Ill Patients Followed Up in Red Zone

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Room ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Demographic Data ◽  
Waiting Times ◽  
Annual Number ◽  
Mortality And Morbidity ◽  
Lengths Of Stay

Objectives: The patients in red zone areas face acute or potentially life-threatening situations, complaints, vital disorders, diseases, or injuries that require emergent evaluation and treatment to prevent probable mortality and morbidity. We aimed to determine the variations in the lengths of stay of patients at the emergency department by examining different parameters and evaluate determinants that affect lengths of stay (in emergency room) of critically ill patients. Materials and Methods: All emergency department patients that were followed up in the red zone were included in this study. Patients’ demographic data, major complaints on admission, vital findings, performed procedures and examinations, elapsed time for the diagnoses, patients’ lengths of stay, and the causes of their prolonged waiting times were recorded and statistically analyzed. Results: The times elapsed for the diagnoses ranged between 6 min to 18 h in this study (mean: 1.62 ± 1.79 h). Patients’ lengths of stay was between 6 min to 58 h (mean length of stay was 5.51 ± 5.73 h). The waiting time for cases that required consultation (7.17 h) was found to be statistically longer than those cases that required no consultations (3.40 h). Conclusion: To prevent delays in emergency room to inpatient unit transfers, hospital administrators should manage their bed capacities to a level that is compatible with the annual number of patient admissions. Increasing the number of geriatric wards may facilitate inpatient transfers of patients over 60 years age from emergency room and shorten the length of stay of that age group.

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

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