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  • Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact of age, patient's clinical acuity and complexity, and care pathways

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Original article
Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact of age, patient's clinical acuity and complexity, and care pathways
  1. Enrique Casalino1,2,3,
  2. Mathias Wargon1,2,3,
  3. Anne Peroziello1,4,
  4. Christophe Choquet1,3,
  5. Christophe Leroy5,
  6. Sebastien Beaune6,
  7. Laurent Pereira1,2,3,
  8. Julien Bernard1,2,3,
  9. Jean-Claude Buzzi4
  1. 1Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France
  2. 2Université Paris Diderot, Sorbonne Paris Cité, France
  3. 3Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
  4. 4Medical Information Systems Program (PMSI), University Hospital Bichat-Claude Bernard, Paris, France
  5. 5Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Louis Mourier, Paris, France
  6. 6Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Beaujon, Paris, France
  1. Correspondence to Professor Enrique Casalino, Service d'Accueil des Urgences, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; enrique.casalino{at}bch.aphp.fr

Abstract

Background It has been reported that emergency department length of stay (ED-LOS) for older patients is longer than average. Our objective was to determine the effect of age, patient's clinical acuity and complexity, and care pathways on ED-LOS and ED plus observation unit (EDOU) LOS (EDOU-LOS).

Methods This was a prospective, multicentre, observational study including all patients attending in 2011. Age groups were: I, <50; II, ≥50–64; III, ≥65–74; IV, ≥75–84; V, ≥85 years. Univariate and multivariate analyses were performed.

Results Of 125 478 attendances, 20 845(16.6%) were of patients aged ≥65 years. Multivariate analysis found significant predictors for ED-LOS (C-statistics 0.79, p<0.0000001) to be: arrival mode (ambulance, OR 1.13 (95% CI 1.08 to 1.18)); acuity level (level 4, OR 1.24 (95% CI 1.21 to 1.28); level 1–3, OR 1.54 (95% CI 1.5 to 1.59)); haematological examinations (OR 3.34 (95% CI 3.15 to 3.56)); intravenous treatment (OR 1.58 (95% CI 1.47 to 1.69)); monitoring of vital signs (OR 1.89 (95% CI 1.69 to 2.10)); x-ray examinations (OR 1.53 (95% CI 1.45 to 1.61)); CT/MRI/ultrasound (OR 2.60 (95% CI 2.39 to 2.82)); and specialist advice (OR 1.39 (95% CI 1.30 to 1.48)). For EDOU-LOS (C-statistics 0.81, p<0.0000001) we found: age group (II, OR 1.19 (95% CI 1.16 to 1.22); III, OR 1.42 (95% CI 1.38 to 1.46); IV, OR 1.69 (95% CI 1.65 to 1.74); V, 2.01 (95% CI 1.96 to 2.07)); acuity level (level 4, OR 1.31 (95% CI 1.27 to 1.35); level 1–3, OR 1.71 (95% CI 1.66 to 1.77)); haematological examinations (OR 7.81 (95% CI 7.23 to 8.43)); intravenous treatment (OR 1.95 (95% CI 1.8 to 2.12)); x-ray examinations (OR 1.95 (95% CI 1.85 to 2.06)); CT/MRI/ultrasound (OR 6.74 (95% CI 5.98 to 7.6)); specialist advice (OR 2.24 (95% CI 2.07 to 2.42)); admission to a medical or surgical ward (OR 0.61 (95% CI 0.54 to 0.68)); and transfer (OR 1.79 (95% CI 1.54 to 2.07)).

Conclusions Whereas ED-LOS and EDOU-LOS seem to be directly related to patients’ acuity and complexity, notably the need for diagnostic and therapeutic interventions, only EDOU-LOS was significantly associated with age and proposed care pathways. We propose that EDOU-LOS measurement should be made in EDs with an OU.

  • Clinical Management
  • Emergency Department Management
  • Clinical Care

https://doi.org/10.1136/emermed-2012-202155

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