Prolonged Length of Stay in the Emergency Department and Increased Risk of In-Hospital Cardiac Arrest: A nationwide Population-Based Study in South Korea, 2016–2017

This study was to determine whether prolonged emergency department (ED) length of stay (LOS) is associated with increased risk of in-hospital cardiac arrest (IHCA). A retrospective cohort with a nationwide database of all adult patients who visited the EDs in South Korea between January 2016 and December 2017 was performed. A total of 18,217,034 patients visited an ED during the study period. The median ED LOS was 2.5 h. IHCA occurred in 9,180 patients (0.2%). IHCA was associated with longer ED LOS (4.2 vs. 2.5 h), and higher rates of intensive care unit (ICU) admission (58.6% vs. 4.7%) and in-hospital mortality (35.7% vs. 1.5%). The ED LOS correlated positively with the development of IHCA (Spearman ρ = 0.91; p < 0.01) and was an independent risk factor for IHCA (odds ratio (OR) 1.10; 95% confidence interval (CI), 1.10–1.10). The development of IHCA increased in a stepwise fashion across increasing quartiles of ED LOS, with ORs for the second, third, and fourth relative to the first being 3.35 (95% CI, 3.26–3.44), 3.974 (95% CI, 3.89–4.06), and 4.97 (95% CI, 4.89–5.05), respectively. ED LOS should be reduced to prevent adverse events in patients visiting the ED.

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Sulfonylurea antidiabetics are associated with lower risk of out‐of‐hospital cardiac arrest: Real‐world data from a population‐based study

British Journal of Clinical Pharmacology ◽

10.1111/bcp.14774 ◽

2021 ◽

Author(s):

Talip E. Eroglu ◽

Lixia Jia ◽

Marieke T. Blom ◽

Arie O. Verkerk ◽

Harsha D. Devalla ◽

...

Keyword(s):

Cardiac Arrest ◽

Real World ◽

Lower Risk ◽

Population Based ◽

Real World Data ◽

Population Based Study ◽

World Data ◽

Hospital Cardiac Arrest

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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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Long-term cognitive outcomes following out-of-hospital cardiac arrest: A population-based study

Neurology ◽

10.1212/wnl.0b013e318232ab33 ◽

2011 ◽

Vol 77 (15) ◽

pp. 1438-1445 ◽

Cited By ~ 50

Author(s):

F. J. Mateen ◽

K. A. Josephs ◽

M. R. Trenerry ◽

M. D. Felmlee-Devine ◽

A. L. Weaver ◽

...

Keyword(s):

Cardiac Arrest ◽

Population Based ◽

Cognitive Outcomes ◽

Population Based Study ◽

Hospital Cardiac Arrest

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Factors associated with out-of-hospital cardiac arrest with pulseless electric activity: A population-based study

American Heart Journal ◽

10.1016/j.ahj.2016.04.018 ◽

2016 ◽

Vol 177 ◽

pp. 129-137 ◽

Cited By ~ 9

Author(s):

Dennis T. Ko ◽

Feng Qiu ◽

Maria Koh ◽

Paul Dorian ◽

Sheldon Cheskes ◽

...

Keyword(s):

Cardiac Arrest ◽

Electric Activity ◽

Population Based ◽

Population Based Study ◽

Factors Associated ◽

Hospital Cardiac Arrest

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Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in Japan

Critical Care ◽

10.1186/cc11864 ◽

2012 ◽

Vol 16 (6) ◽

pp. R219 ◽

Cited By ~ 3

Author(s):

Seizan Tanabe ◽

Hideo Yasunaga ◽

Soichi Koike ◽

Manabu Akahane ◽

Toshio Ogawa ◽

...

Keyword(s):

Cardiac Arrest ◽

Population Based ◽

Population Based Study ◽

Hospital Cardiac Arrest

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298 End-Tidal Carbon Dioxide Monitoring and the Possibility of Return of Spontaneous Circulation During Out-of-Hospital Cardiac Arrest: A Population-Based Study

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2015.07.332 ◽

2015 ◽

Vol 66 (4) ◽

pp. S108

Author(s):

P.-L. Cheng ◽

Y.-C. Su

Keyword(s):

Carbon Dioxide ◽

Cardiac Arrest ◽

Population Based ◽

Spontaneous Circulation ◽

Population Based Study ◽

Return Of Spontaneous Circulation ◽

End Tidal Carbon Dioxide ◽

Carbon Dioxide Monitoring ◽

End Tidal ◽

Hospital Cardiac Arrest

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Incidence and survival rate of bystander-witnessed out-of-hospital cardiac arrest with cardiac etiology in Osaka, Japan: a population-based study according to the Utstein style

Resuscitation ◽

10.1016/s0300-9572(03)00241-7 ◽

2003 ◽

Vol 59 (3) ◽

pp. 329-335 ◽

Cited By ~ 38

Author(s):

Tatsuya Nishiuchi ◽

Atsushi Hiraide ◽

Yasuyuki Hayashi ◽

Toshifumi Uejima ◽

Hiroshi Morita ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Population Based ◽

Population Based Study ◽

Utstein Style ◽

Hospital Cardiac Arrest

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Risk of out-of-hospital cardiac arrest among sepsis survivors in Taiwan: analysis of a nationwide population-based cohort

BMJ Open ◽

10.1136/bmjopen-2021-051502 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051502

Author(s):

Wan-Ting Hsu ◽

Charles Fox Sherrod ◽

Babak Tehrani ◽

Alexa Papaila ◽

Lorenzo Porta ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Cox Regression ◽

Population Based ◽

National Database ◽

Secondary Outcome ◽

Research Database ◽

Increased Risk ◽

Matching Techniques ◽

Hospital Cardiac Arrest

ObjectivesThere is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.DesignPopulation-based cohort study.SettingNationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.ParticipantsWe included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.Primary and secondary outcome measuresThe main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.ResultsCompared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81).ConclusionsSepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.

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