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      Admission Decisions Made by Emergency Physicians Can Reduce the Emergency Department Length of Stay for Medical Patients

      research-article
      Author(s): 1 , 2 , 1 , , 3
      Publication date (Electronic):
      Journal: Emergency Medicine International
      Publisher: Hindawi

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          Abstract

          Background

          Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing treatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and are associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by emergency physicians without consultations on the ED LOS and other quality indicators.

          Methods

          The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions that was implemented in October 2016. During and after the policy change, emergency physicians decided how to arrange for and treat medical patients by processing their admission and providing follow-up care without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared between the study period (January to June 2017) and the control period (January to June 2016).

          Results

          The median ED LOS of patients admitted to the IM department decreased from 673 (IQR: 347–1,369) minutes in the control period to 237 (IQR: 166–364) minutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality between the two periods.

          Conclusions

          The admission decisions regarding medical patients made by emergency physicians without specialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS.

          Related collections

          Most cited references26

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          International perspectives on emergency department crowding.

          Jesse M. Pines, Joshua A. Hilton, Ellen J Weber … (2011)
          The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes. © 2011 by the Society for Academic Emergency Medicine.
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            Analysis of factors influencing length of stay in the emergency department.

            Tehshik Yoon, Gilles Reinhardt, I Steiner (2003)
            Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels. In this retrospective review, conducted at a large urban tertiary care teaching hospital and trauma centre, investigators reviewed the records of 1047 consecutive patients treated during a continuous 7-day period in January 1999. Key data were recorded, including patient characteristics, ED process times, tests performed, consultations and overall ED LOS. Of the 1047 patient records, 153 (14.6%) were excluded from detailed analysis because of incomplete documentation. Process times were determined and stratified by triage level, using the Canadian Emergency Department Triage and Acuity Scale (CTAS). Multiple linear regression analysis was performed to determine which factors were most strongly associated with prolonged LOS. Patients in intermediate triage Levels III and IV generally had the longest waiting times to nurse and physician assessment, and the longest ED lengths of stay. CTAS triage levels predicted laboratory and imaging utilization as well as consultation rate. The use of diagnostic imaging and laboratory tests was associated with longer LOS, varying with the specific tests ordered. Specialty consultation was also associated with prolonged LOS, and this effect was highly variable depending on the service consulted. Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.
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              The Korean Triage and Acuity Scale: associations with admission, disposition, mortality and length of stay in the emergency department.

              Hyuksool Kwon, Yu Jin Kim, You Hwan Jo … (2019)
              The Korean Triage and Acuity Scale (KTAS) was implemented in our emergency department (ED) in May 2016 and is fully integrated into the electronic medical record (EMR) system. Our objective was to determine whether the KTAS is associated with changes in admissions to the hospital, admission disposition, inpatient mortality and length of stay (LOS).
              Article 0 comments Cited 25 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jinwoo Jeong:
                ORCID: https://orcid.org/0000-0003-1745-5127
                Journal
                Journal ID (nlm-ta): Emerg Med Int
                Journal ID (iso-abbrev): Emerg Med Int
                Journal ID (publisher-id): EMI
                Title: Emergency Medicine International
                Publisher: Hindawi
                ISSN (Print): 2090-2840
                ISSN (Electronic): 2090-2859
                Publication date Collection: 2020
                Publication date (Electronic): 11 February 2020
                Volume: 2020
                Electronic Location Identifier: 8392832
                Affiliations
                1Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
                2Department of Medicine, Graduate School of Dong-A University, Busan, Republic of Korea
                3Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
                Author notes

                Academic Editor: Joe Nemeth

                Author information
                https://orcid.org/0000-0003-1214-0820
                https://orcid.org/0000-0003-1745-5127
                Article
                DOI: 10.1155/2020/8392832
                PMC ID: 7036127
                SO-VID: e85d28e3-0fdc-4a53-a146-76ce6b0b7e76
                Copyright © Copyright © 2020 Yuri Choi et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 November 2019
                Date revision received : 8 January 2020
                Date accepted : 20 January 2020
                Funding
                Funded by: Dong-A University
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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