Patient characteristics associated with longer emergency department stay: a rapid review

Kreindler, Sara A.; Yang, Cui; Metge, Colleen; Raynard, Melissa

doi:10.1136/emermed-2015-204913

Cited by 54 publications

(66 citation statements)

References 50 publications

(118 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Admission from ED, however, is based on factors outside the control of the ED, namely bed availability on the wards providing the right levels of care required. The evidence base showing that patients admitted to the hospital have longer ED LoS compared to ED discharges is substantial and consistent . In the USA and more recently in Australia, ED LoS is reported separately for discharges and admissions.…”

Section: Introductionmentioning

confidence: 96%

Predictors of a long length of stay in the emergency department for older people

Sweeny

Keijzers

O’Dwyer

et al. 2020

Internal Medicine Journal

View full text Add to dashboard Cite

Background Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities. Aims To identify predictors of a long ED length of stay (LLoS) for patients ≥65 years old. Methods Linked hospital information systems data from a large, public Australian ED were analysed in this retrospective cohort study. LLoS was defined as the 75th percentile (617 min). Multivariate regression identified LLoS predictors for admissions and discharges separately. Results Of 16 791 ED presentations made by older people, 4192 experienced a LLoS; 55% were admitted. Increasing age was associated with an increasing ED LoS. Factors most predictive of LLoS for both admitted and discharged patients included: investigations (both pathology and imaging), less urgent Australasian triage scale categories and after‐hours arrival. Ambulance arrival did not increase the risk of a LLoS for patients eventually admitted, but conferred nearly a twofold increased risk for a LLoS for discharged older persons (adjusted odds ratios = 1.9; 95% confidence interval 1.5–2.4). Conclusions This study assists clinicians and decision‐makers to identify reasons why older persons have a LLoS, whether admitted or discharged. Interventions to streamline care for older patients arriving after‐hours and who require imaging and pathology are required. LoS targets should consider age distribution. The use of ED LoS as a quality of care indicator should be assessed for admissions and discharges, separately.

show abstract

Section: Introductionmentioning

confidence: 96%

Predictors of a long length of stay in the emergency department for older people

Sweeny

Keijzers

O’Dwyer

et al. 2020

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…In addition, the patient age was an important predictor of nursing time in different settings; the older the patient was, the more time nurses spent with direct care of patients (McGillis Hall, Doran, & Pink, ; O'Brien Pallas, Irvine, Peereboom, & Murray, ). Higher age in ED patients, besides its correlation with JDT, was associated with longer ED‐LOS (Kreindler, Cui, Metge, & Raynard, ) and both age and ED‐LOS predicted hospital admission (Crilly et al, ). In terms of hospitalisation, these findings indicate that the nursing care needs of hospitalised patients were higher in comparing to those of the home‐discharged patients.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of an assessment tool for nursing workload in emergency departments

Iordache

Elseviers

Cock

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims To develop the Workload Assessment of Nurses on Emergency (WANE) tool and to test its validity and reliability to measure nursing workload in the emergency departments. Background Ensuring safe nursing staffing in emergency departments is a worldwide concern. There is no valid tool to measure emergency nursing workload in order to determine the needed nurse staffing in the emergency departments. Design A two‐year, cross‐sectional, multicenter study. Methods Workload was operationalised as the time nurses spent with nursing activities, classified into direct and indirect care. A board of experts provided content validity. Construct validity was evaluated by examining the WANE's correlations and group‐discriminations patterns within the network of variables known to determine nursing workload. Reliability was assessed by the tool's ability to yield consistent results across repeated measurements. Reporting of this research adheres to STROBE guidelines. Results Seven emergency departments, including 3,024 patients, were involved in the first year and 18 emergency departments and 7,442 patients in the second year. Direct care time correlated positively and significantly with patient dependency on nursing care, age and length of emergency department stay and discriminated between the categories of dependency on nursing care, age and hospitalisation. Both direct and indirect care time discriminated between the emergency departments according to different patient care profiles and unit characteristics. WANE showed consistent results across measurements. Conclusions Results support the WANE's reliability and validity to measure emergency nursing workload. This tool could be used to determine, on patient and unit, a baseline nurse staffing and the nursing skill mix in the emergency departments. WANE is also an evidence‐based management tool for benchmarking purposes. Relevance to clinical practice The use of an evidence‐based workload tool in making staffing decisions in emergency departments is crucial to ensure safe patient care and prevent work overload in nursing staff.

show abstract

“…The causes of crowding are multifactorial and include, among the major contributors, the length of stay (LOS) of ED patients [3]. Evidence suggests that lengthy visits impact is more relevant than non-…”

Section: Conclusion : the Effectiveness Of The Anticipation Of Bloodmentioning

confidence: 99%

“…Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status Background:The American College of Emergency Physicians defines crowding as a need for emergency services exceeding available resources for patient care in the Emergency Department (ED), hospital or both [1]. In particular, ED crowding is considered a public health issue worldwide [2], because its consequences include diminished patients and staff satisfaction, decreased patients safety (delays in the evaluation and treatment of emergency patients, increased morbidity and mortality), increased costs, and reputation damage [1].The causes of crowding are multifactorial and include, among the major contributors, the length of stay (LOS) of ED patients [3]. Evidence suggests that lengthy visits impact is more relevant than non-…”

mentioning

confidence: 99%

Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

Strada¹,

Bolognesi²,

Manzoli³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) -a main cause of overcrowding -remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called "diagnostic anticipation", which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians.Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression.Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients'condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status Background:The American College of Emergency Physicians defines crowding as a need for emergency services exceeding available resources for patient care in the Emergency Department (ED), hospital or both [1]. In particular, ED crowding is considered a public health issue worldwide [2], because its consequences include diminished patients and staff satisfaction, decreased patients safety (delays in the evaluation and treatment of emergency patients, increased morbidity and mortality), increased costs, and reputation damage [1].The causes of crowding are multifactorial and include, among the major contributors, the length of stay (LOS) of ED patients [3]. Evidence suggests that lengthy visits impact is more relevant than non-

show abstract

Patient characteristics associated with longer emergency department stay: a rapid review

Cited by 54 publications

References 50 publications

Predictors of a long length of stay in the emergency department for older people

Predictors of a long length of stay in the emergency department for older people

Development and validation of an assessment tool for nursing workload in emergency departments

Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

Contact Info

Product

Resources

About