Exploring Potential Association Between Emergency Department Crowding Status and Patients’ Length of Stay at a University Hospital in Saudi Arabia

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.

Download Full-text

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

10.21203/rs.3.rs-20219/v1 ◽

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

Download Full-text

Admissions for drug-related problems at the Emergency Department of a University Hospital in the Kingdom of Saudi Arabia

Journal of Family and Community Medicine ◽

10.4103/2230-8229.149590 ◽

2015 ◽

Vol 22 (1) ◽

pp. 44 ◽

Cited By ~ 8

Author(s):

MohammadA Randhawa ◽

MohyeH Al-Wahhas ◽

MohammadA Al-Jumaan ◽

MastourS Alghamdy

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

University Hospital ◽

Drug Related Problems ◽

Kingdom Of Saudi Arabia

Download Full-text

The Effect of Emergency Department Crowding on Length of Stay and Medication Treatment Times in Discharged Patients With Acute Asthma

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2010.00780.x ◽

2010 ◽

Vol 17 (8) ◽

pp. 834-839 ◽

Cited By ~ 38

Author(s):

Jesse M. Pines ◽

Anjeli Prabhu ◽

Joshua A. Hilton ◽

Judd E. Hollander ◽

Elizabeth M. Datner

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Acute Asthma ◽

Emergency Department Crowding ◽

Medication Treatment ◽

Discharged Patients

Download Full-text

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

BioMed Research International ◽

10.1155/2014/690368 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Pierre-Nicolas Carron ◽

Bertrand Yersin ◽

Lionel Trueb ◽

Philippe Gonin ◽

Olivier Hugli

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Tertiary Hospital ◽

Medical Advice ◽

University Hospital ◽

Against Medical Advice ◽

Missed Opportunities ◽

Left Without Being Seen ◽

Frequent Reason ◽

Retrospective Database

Aim.The study aimed at describing the evolution over a 6-year period of patients leaving the emergency department (ED) before being seen (“left without being seen” or LWBS) or against medical advice (“left against medical advice” or LAMA) and at describing their characteristics.Methods.A retrospective database analysis of all adult patients who are admitted to the ED, between 2005 and 2010, and who left before being evaluated or against medical advice, in a tertiary university hospital.Results.During the study period, among the 307,716 patients who were registered in the ED, 1,157 LWBS (0.4%) and 1,853 LAMA (0.9%) patients were identified. These proportions remained stable over the period. The patients had an average age of38.5±15.9years for LWBS and41.9±17.4years for LAMA. The median time spent in the ED before leaving was 102.4 minutes for the LWBS patients and 226 minutes for LAMA patients. The most frequent reason for LAMA was related to the excessive length of stay.Conclusion.The rates of LWBS and LAMA patients were low and remained stable. The patients shared similar characteristics and reasons for leaving were largely related to the length of stay or waiting time.

Download Full-text

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

10.21203/rs.2.16591/v1 ◽

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.

Download Full-text

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

10.21203/rs.3.rs-20587/v1 ◽

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.

Download Full-text