Emergency Department Waiting Times and Determinants of Prolonged Length of Stay in a Botswana Referral Hospital

Abstract

Introduction: Emergency medicine is a critical component of quality public health service. In fact length of stay and waiting times in the Emergency department are key indicators of quality. The aim of this study was to determine waiting times and determinants of prolonged length of stay (LOS) in the Princess Marina Hospital Emergency Department. Methods: This was a retrospective observational study. It was done at Princess Marina, a referral hospital in Gaborone, Botswana. Triage forms of patients who presented between 19/11/ 2018 and 18/12/2018 were reviewed. Data from patient files was used to determine time duration from triage to being reviewed by a doctor, time duration from review by emergency doctor to patients' disposition and the time duration from patient's triage to disposition (length of stay). Prolonged length of stay was defined as duration > 6 hours. Results: A total of 1052 files representing patients seen over a 1-month period were reviewed. 72.5% of the patients had a prolonged length of stay. The median emergency doctor waiting time was 4.5 hours (IQR 1.6-8.3 hours) and the maximum was 27.1 hours. The median length of stay in the emergency department was 9.6 hours (IQR 5.8-14.6 hours) and the maximum was 45.9 hours. Patient's age (AOR 1.01), mental status (AOR 0.61), admission to internal medicine service (AOR 5.12) and pediatrics admissions (AOR 0.11) were significant predictors of prolonged length of stay in the emergency department. Conclusion: Princess Marina Hospital emergency department waiting times and length of stay are long. Age, normal mental status and internal medicine admission were independent predictors of prolonged stay (>6 hours). Admission to the pediatrics service was associated with shorter length of stay. There is a need for interventions to address the long waiting times and length of stay. Interventions should particularly focus on the identified predictors.

Health-related reasons patients transfer from a clinic or health post to the Emergency Department in a District Hospital in Botswana

“…The increased length of stay in the EC is primarily due to other factors such as the laboratory results and radiological imaging turnaround times [27] . Similarly, in a Botswana tertiary hospital, organizational variables such as multiple referrals and investigations were the leading causes of a lengthy stay in the EC [15] .…”

“…Nonetheless, because the Botswana referral system follows a hierarchical order in which patients travel through the district hospital before reaching the tertiary hospital, some patients are further transferred to a tertiary hospital, adding to the delay in patient management. A study in Botswana showed that 14.6% of trauma patients died after arriving at the secondary hospital [15] . The findings underscore the necessity for direct transfers to higher-level facilities without following a hierarchical referral system.…”

“…Due to a shortage of transportation choices, Fraser [13] observed that patients are not usually transferred to the hospital immediately, resulting in delayed care. The emergency centre's (EC) role is to provide initial triage, treatment, and stabilization of patients before admission to their respective inpatient units [ 14 , 15 ]. Patients with various medical requirements from health posts and clinics are transferred to the district hospital's EC.…”

Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa

“…Sub-Saharan African countries recognised that prolonged LOS has become a daily reality affecting the functionality of the EDs and reached consensus that further investigations was vital to try and reduce prolonged LOS in the ED [ 22 , 23 ]. The study conducted in Botswana found that ED waiting times and length of stay were prolonged [ 24 ]. Although it was indicated in the study conducted in Nigeria that the ideal ED LOS was 6 h, findings from the study conducted in a teaching hospital ED showed patient ED stay of over 24 h [ 25 ].…”

Big Data-Enabled Analysis of Factors Affecting Patient Waiting Time in the Nephrology Department of a Large Tertiary Hospital

“…There have been many studies into waiting time in healthcare institutions, focusing mainly on outpatients [ 14 , 15 ] and Emergency Departments [ 16 , 17 ]. The research has mostly been carried out from the perspective of the country, the region, or the entire hospital [ 18 , 19 ].…”