Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada

Abstract

Objective To determine whether patients who are not admitted to hospital after attending an emergency department during shifts with long waiting times are at risk for adverse events.Design Population based retrospective cohort study using health administrative databases.Setting High volume emergency departments in Ontario, Canada, fiscal years 2003-7. Participants All emergency department patients who were not admitted (seen and discharged; left without being seen).Outcome measures Risk of adverse events (admission to hospital or death within seven days) adjusted for important characteristics of patients, shift, and hospital. Results 13 934 542 patients were seen and discharged and 617 011 left without being seen. The risk of adverse events increased with the mean length of stay of similar patients in the same shift in the emergency department. For mean length of stay ≥6 v <1 hour the adjusted odds ratio (95% confidence interval) was 1.79 (1.24 to 2.59) for death and 1.95 (1.79 to 2.13) for admission in high acuity patients and 1.71 (1.25 to 2.35) for death and 1.66 (1.56 to 1.76) for admission in low acuity patients). Leaving without being seen was not associated with an increase in adverse events at the level of the patient or by annual rates of the hospital.Conclusions Presenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department. Patients who leave without being seen are not at higher risk of short term adverse events.

Overcrowding in emergency department: an international issue

“…The potential utility of clinical indicators Long waits in the ED not only contribute to the problem of overcrowding, but also are associated with increased patient morbidity and mortality [5,9,[12][13][14]. The long delays experienced by patients attempting to access emergency care in the United Kingdom gained a high profile in the 1990s, and led to the United Kingdom being the first country to introduce mandatory, nationwide clinical indicators [15].…”

Effect of emergency physician burnout on patient waiting times

“…8,10,24,25 As burnout syndrome may cause a decreased productivity among workers, we investigated whether it is associated with longer WT for patients. In our study, we found that a high burnout level in emergency physicians working a given day was independently associated with a greater risk for an exceeded target WT (OR 1.53, 95%CI [1.38 to 1.69]) This is the first study examining the influence of burnout amongst emergency physicians on patient care.…”

“…Prolonged WT in the ED has been reported to be associated with worse outcomes and a higher risk for delayed treatment and adverse events. [6][7][8][9] For these reasons, WT is a key performance indicator in many countries and one of the several quality indicators of the National Quality Forum. 10,11 There are a few previously reported independent predictors of prolonged WT (time of day of the ED visit, age of the patient, overcrowding or daily census for example).…”

Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

“…The MDRNSTAT intervention was found to significantly decrease median PIA time and median EDLOS for high (CTAS 48 [2][3] and low (CTAS [4][5] acuity, discharged patients not requiring a consultation. Consequently, morbidity, mortality, patient satisfaction, and expense-associated with prolonged EDLOS could be partially mitigated by such a program; however, its implementation consumes health care resources that could potentially be used elsewhere.…”