Objectives. The time emergency department (ED) patients spend from presentation to admittance is known as their length of stay (LOS). This study aimed to quantify the inpatient occupancy rate (InptOcc)/ED LOS relationship and develop a methodology for identifying resource-allocation triggers using InptOcc-LOS association-curve inflection points.Methods. This study was conducted over 200 consecutive days at a 700-bed hospital with an annual ED census of approximately 50,000 using multivariate spline (piecewise) regression to model the InptOcc/LOS relationship while adjusting for confounding covariates. Nonlinear modeling was used to assess for InptOcc/LOS associations and determine the inflection point where InptOcc profoundly impacted LOS.Results. At lower InptOcc, there was no association. Once InptOcc reached ≥88%, there was a strong InptOcc/LOS association; each 1% InptOcc increase predicted a 16-minute (95% CI, 12–20 minutes) LOS prolongation, while the confounder-adjusted analysis showed each 1% InptOcc increase >89% precipitating a 13-minute (95% CI, 10–16 minutes) LOS prolongation.Conclusions. The study hospital’s InptOcc was a significant predictor of prolonged ED LOS beyond the identified inflection point. Spline regression analysis identified a clear inflection point in the InptOcc-LOS curve that potentially identified a point at which to optimize inpatient bed availability to prevent increased costs of prolonged LOS.
community site. The post-DTU cohort included all consecutive adult emergency patients who presented to the study sites in the six months post-DTU implementation (October 11, 2012 at the tertiary site and September 29, 2012 at the community site). The slightly different study periods reflect the different opening dates of the DTUs. Standard descriptive statistics were generated, and P<0.05 was considered statistically significant for the pre/post comparisons of the co-primary outcomes.Results: Of the 56,832 patients who presented to the study sites in the six months after the DTU implementation, 1.92% (527) were admitted to the DTU at the community ED and 1.42% (416) at the tertiary ED. Implementation of the DTU was associated with an increased median ED LOS (179 minutes pre versus 192 minutes post, P<0.01) at the community site and no change in the ED LOS at the tertiary site (182 minutes pre versus 182 minutes post, P¼0.55). DTU implementation was associated with a significant decrease in the rate of patient admissions at the community ED (17.8% pre versus 17.0% post, P<0.01) and a non-significant trend towards a decrease at the tertiary ED (18.9% pre versus 18.3% post, P¼0.09).Conclusions: Our results suggest that a multi-diagnosis DTU can reduce hospital admission rate but also that the presence and/or magnitude of this effect may be site-specific. In contrast to previous studies, we found no evidence that a DTU reduced ED LOS. Further research is needed to identify site-specific characteristics to help determine whether DTUs are a helpful strategy to reduce ED crowding.
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