Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

Zhang, Zhongheng; Bokhari, Faran; Guo, Yizhan; Goyal, Hemant

doi:10.1136/emermed-2018-208032

Cited by 78 publications

(95 citation statements)

References 25 publications

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“…A previous study showed that clinical outcomes were not significantly different between early and delayed ICU admissions in sepsis patients. [13] In contrast, Zhang et al showed increased in-hospital mortality when sepsis Emergency Medicine International patients requiring ICU admission stayed longer than 12 hours in the ED [14]. Several reasons may cause delayed ICU admissions including delayed decision by the ED physician, shortage of ICU beds, waiting for radiologic examination, and ED crowding.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain

Dadeh

Phunyanantakorn

2020

Emergency Medicine International

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Objective. We aimed to identify factors affecting length of stay in the emergency department in patients who presented with abdominal pain. Methods. A retrospective cohort study was conducted from 1 January 2017 to 31 December 2017. The medical records were reviewed from 217 patients older than 15 years with the chief complaint of abdominal pain. The patients were divided into emergency department length of stay (EDLOS) < 4 hours and ≥4 hours. The two groups were compared in terms of baseline characteristics, physical examination, time of presenting, attending physicians, interdepartmental consultations, investigations, ED disposition, final diagnosis, and mortality. The significant factors affecting longer EDLOS were examined using univariate and multivariate analyses by logistic regression. Results. Factors affecting longer EDLOS were age ≥50 (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.36–7.42), interdepartmental consultation ≥2 specialists (OR 71.82, 95% CI 5.67–909.51), blood testing ≥2 rounds (OR 85.6, 95% CI 4.22–1734.6), and ultrasonography (OR 8.28, 95% CI 1.84–37.26). Conclusion. The study found that the statistically significant factors that prolonged EDLOS in patients with the chief complaint of abdominal pain were age, rounds of blood test, interdepartmental consultation, and the need for ultrasonography.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain

Dadeh

Phunyanantakorn

2020

Emergency Medicine International

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“…Even if there is no causal relationship between longer ED stay and mortality, longer ED stay has shown harmful consequences [ 21 ]. There were numerous studies reported about relationships between prolonged LOS and increased mortality in various situations [ 22 , 23 ]. Guttmann et al analyzed a nationwide data of Canadian ED data and found that longer waiting patients in ED showed higher short-term mortality [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Guttmann et al analyzed a nationwide data of Canadian ED data and found that longer waiting patients in ED showed higher short-term mortality [ 22 ]. A more recent retrospective study also announced that ED LOS was an independent risk factor for in-hospital mortality among sepsis patients requiring ICU admission [ 23 ]. In addition, our finding suggested that higher mortality might be mainly due to a higher incidence of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Length of Stay in the Emergency Department and Increased Risk of In-Hospital Cardiac Arrest: A nationwide Population-Based Study in South Korea, 2016–2017

Kim

Seo

Jeong

et al. 2020

JCM

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This study was to determine whether prolonged emergency department (ED) length of stay (LOS) is associated with increased risk of in-hospital cardiac arrest (IHCA). A retrospective cohort with a nationwide database of all adult patients who visited the EDs in South Korea between January 2016 and December 2017 was performed. A total of 18,217,034 patients visited an ED during the study period. The median ED LOS was 2.5 h. IHCA occurred in 9,180 patients (0.2%). IHCA was associated with longer ED LOS (4.2 vs. 2.5 h), and higher rates of intensive care unit (ICU) admission (58.6% vs. 4.7%) and in-hospital mortality (35.7% vs. 1.5%). The ED LOS correlated positively with the development of IHCA (Spearman ρ = 0.91; p < 0.01) and was an independent risk factor for IHCA (odds ratio (OR) 1.10; 95% confidence interval (CI), 1.10–1.10). The development of IHCA increased in a stepwise fashion across increasing quartiles of ED LOS, with ORs for the second, third, and fourth relative to the first being 3.35 (95% CI, 3.26–3.44), 3.974 (95% CI, 3.89–4.06), and 4.97 (95% CI, 4.89–5.05), respectively. ED LOS should be reduced to prevent adverse events in patients visiting the ED.

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“…Studies have shown that a prolonged LOS at an ED is independently associated with an increased risk of in-hospital mortality in critically ill patients, even in those without time-sensitive diseases requiring ICU admission such as severe sepsis or septic shock. [14,15] Increased LOSs in acute care beds and the ICU could increase the financial burden, decrease health-related quality of life and increase the risks of developing complications such as hospital-acquired infections and ICU-acquired weakness. [16,17] We assume that the committed and organized support gained by following the MCI protocol could minimize the impacts on the EDs and hospitals.…”

Section: Discussionmentioning

confidence: 99%

The crowd-out effect of a mass casualty incident

et al. 2019

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A mass casualty incident (MCI) can have an enormous impact on an already crowded emergency department (ED), affecting the quality of health care provided to non-MCI ED patients. On June 26, 2015, a burn MCI (BMCI) occurred due to a cornstarch explosion at a party at a water park. The competing needs of the BMCI patients might have crowded out the needs of the non-BMCI patients. Although crowd-out effects have been previously documented in a variety of health care situations, they have not been extensively evaluated during MCIs. We aimed to determine whether the outcomes of the non-MCI patients were compromised during this incident. We conducted a retrospective observational study comparing several health care parameters and outcomes between non-BMCI patients and historical controls during the designated period using institutional electronic records and the National Health Insurance Research Database. On the night of the incident, 53 patients were sent to our ED; most of them arrived within 3 hours after the BMCI. There was a significant increase in the wait time for ICU beds among non-BMCI patients compared to the wait times during the corresponding week of the previous year (8.09 ± 4.21 hours vs 3.77 ± 2.15 hours, P = .008). At the hospital level, there was a significantly increased length of hospital stay (LOS) in the ICU after the MCI compared with the LOS in the ICU in the same week of the preceding year (median days: 15 vs 8, P ≤ .001). At the regional level, there were no significant differences between the 2 periods in the LOS in acute care, LOS in the ICU or mortality rates at the involved medical centers. Crowd-out effects from the MCI occurred in the ED and at the institutional level. Although there was an increased wait time for admission to the ICU and a longer LOS in the ICU, the LOS in acute care beds, treatment of time-sensitive diseases, and mortality rates were not compromised by the current MCI protocol at either the institutional or regional levels.

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Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

Cited by 78 publications

References 25 publications

Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain

Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain

Prolonged Length of Stay in the Emergency Department and Increased Risk of In-Hospital Cardiac Arrest: A nationwide Population-Based Study in South Korea, 2016–2017

The crowd-out effect of a mass casualty incident

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