Increasing consultant-level staffing as a proportion of overall physician coverage improves emergency department length of stay targets

Abstract

Objectives One goal of Emergency Department (ED) operations is achieving an overall length of stay (LOS) that is less than four hours. The goal of the current study was to assess for association between increasing number of on-duty EM Consultants and LOS, while adjusting for overall (all-grade) on-duty emergency doctors’ numbers and other operational factors. Methods This was a retrospective analysis of three years (2016–2019) of data, employing a unit of analysis of 3276 eight-hour ED shifts. The study was conducted using a prospectively populated ED database in a busy (annual census 420,000) Middle Eastern ED with staffing by Consultants and multiple non-Consultant grades (Specialists, fellows, and residents). Using logistic regression, the main predictor variable of “on-duty Consultant n” was assessed for association with the study’s primary (dichotomous) endpoint: whether a shift’s median LOS met the target of < 240 min. Linear regression was used to assess for association between on-duty Consultant n and the study’s secondary (continuous) endpoint: median LOS for the ED shift. Results Multivariate logistic regression adjusting for a number of operations factors (including total EP on-duty complement) identified an association between increasing n of on-duty Consultants and the likelihood of a shift’s meeting the 4-h ED LOS target (OR 1.27, 95% CI 1.20 to 1.34, p < .0001). Multiple linear regression, which also adjusted for total on-duty EP n and other operational factors, also indicated LOS benefit from more on-duty Consultants: each additional on-duty Consultant was associated with a shift’s median LOS improving by 5.4 min (95% CI 4.3 to 6.5, p < .0001). Conclusions At the study site, in models that adjusted for overall on-duty EP numbers as well as myriad other operational factors, increasing numbers of on-duty Consultants was associated with a statistically and operationally significant reduction in ED LOS.

Work unit level personnel working hours and the patients’ length of in-hospital stay–An administrative data approach

“…These influential factors were accounted due to the fact that previous studies have shown that adjusting for patient churn increases nurse staffing across all units and shifts [ 36 ]. Increasing number of on-duty health care personnel [ 5 ] or a higher number of night-time staffing [ 9 ] were also assumed to shorten the length of stay. Earlier, an increase in the NPR were shown to reduce the length of stay [ 18 ], although we did not find this effect.…”

“…On the other hand, length of stay is an important indicator of the efficiency of hospital management [ 3 , 4 ]. Increasing number of on-duty health care personnel may shorten the length of stay [ 5 ], and higher average working hours per patient day have predicted shorter length of in-hospital stay [ 6 ]. A greater number of working hours per patient day has been shown to be linked with shorter length of stay also in Finland [ 7 , 8 ].…”

Improvements to emergency department length of stay and user satisfaction after implementation of an integrated consult order

“… 1 , 2 One factor in longer ED LOS is inefficient subspecialty consultation—awaiting consultation is associated with a prolonged inpatient stay, and conversely increasing consultant staffing may reduce LOS. 3 An essential part of the consultation is 2‐way communication. Although modern electronic health records (EHRs) allow consults to be requested via order, 2‐way communication is nonetheless helpful to framing and resolving the consult question.…”

“…Increased length of stay (LOS) in the ED is associated with increased mortality, medical errors, delays in care, and decreased quality of care 1,2 . One factor in longer ED LOS is inefficient subspecialty consultation—awaiting consultation is associated with a prolonged inpatient stay, and conversely increasing consultant staffing may reduce LOS 3 . An essential part of the consultation is 2‐way communication.…”