scholarly journals Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department

2020 ◽  
Vol 1 (6) ◽  
pp. 1660-1668
Author(s):  
Hamid Shokoohi ◽  
Michael A. Loesche ◽  
Nicole M. Duggan ◽  
Andrew S. Liteplo ◽  
Calvin Huang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Independent Predictor ◽  
Intravenous Access ◽  
Prolonged Length

scholarly journals Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erica M. Jones ◽  
Amelia K. Boehme ◽  
Aimee Aysenne ◽  
Tiffany Chang ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Adverse Outcomes ◽  
Stroke Patients ◽  
Significant Independent Predictor ◽  
Prolonged Length ◽  
Stroke Center ◽  
Shift Change

Objectives. Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods. Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results. Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death. Conclusions. Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

2011 ◽  
Vol 70 (6) ◽  
pp. 1317-1325 ◽  
Author(s):  
Nathan T. Mowery ◽  
Stacy D. Dougherty ◽  
Amy N. Hildreth ◽  
James H. Holmes ◽  
Michael C. Chang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Trauma Activation

scholarly journals MP38: The impact of physician handoffs on the outcomes of emergency department patients: a medical administrative database retrospective cohort study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S56-S56
Author(s):  
A. Mokhtari ◽  
D. Simonyan ◽  
A. Pineault ◽  
M. Mallet ◽  
S. Blais ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Physician ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Physicians ◽  
Icu Admission ◽  
The Impact

Introduction: A physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes. Methods: We included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Québec-Université Laval during fiscal year 2016-17. Data were extracted from the local hospital discharge database and the ED information system. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted multilevel multivariate regression analyses, accounting for patient and hospital clusters and adjusting for demographics, CTAS score, comorbidities, admitting department delay before evaluation by an emergency physician and by another specialty, emergency department crowding, initial ED orientation and handoff timing. We conducted sensitivity analyses excluding patients that had an ED length of stay > 24 hours or events that happened after 72 hours of hospitalization. Results: 21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson index score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In multilevel multivariate analysis (OR handoff/no handoff [CI95%] or GMR[SE]), handoff status was not associated with mortality 0.89[0.77,1.02], surgery 0.95[0.85,1.07] or hospital length of stay (-0.02[0.03]). Non-handed-off patients had an increased risk of ICU admission (0.75[0.64,0.87]). ED occupancy rate was an independent predictor of mortality and ICU admission rate irrespectively of handoff status. Sensitivity and sub-group based analyses yielded no further information. Conclusion: Emergency physicians’ handoffs do not seem to increase the risk of severe in-hospital adverse events. ED occupancy rate is an independent predictor of mortality. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity.

scholarly journals The association between length of stay in the emergency department and short term mortality

2019 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carlsson ◽  
Ulf Ekelund ◽  
Olle Melander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Care ◽  
Mortality Rates ◽  
University Hospital ◽  
Short Term ◽  
Opposite Pattern ◽  
Prolonged Length ◽  
Short Term Mortality ◽  
Clinical Urgency

Abstract Background: Prolonged length of stay at the emergency department (ED-LOS) has been associated with increased mortality and hospital stay. The aim of this study was to investigate the association between ED-LOS and 7- and 30-days mortality in patients triaged according to Rapid Emergency Triage and Treatment System – Adult (RETTS-A), the most common used triage tool in Sweden. Methods: All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n=639 385) were included. Logistic regression analysis was used to determine association between prolonged ED-LOS and 7 and 30-days mortality rates. All patients were triaged according to the RETTS-A and subsequently separated into five quintiles of ED-LOS. Results : In patients triaged with the highest medical urgency, longer ED-LOS was associated with a lower risk for 7-days mortality, for triage priority 1: OR 0.94 (CI 95% 0.92-0.96) compared to OR 1.03 (CI 95% 0.99-1.07) for triage priority 4, and for 30-days mortality: OR 0.97 (CI 95% 0.96-0.99) OR for triage priority 1 compared to 1.03 (CI 95% 1.01-1.05) for triage priority 4. In contrast, the opposite pattern appeared evident in the 3 other triage groups, where a longer ED-LOS was generally associated with an increased mortality risk. Pro-longed ED-LOS in patients admitted to in-hospital care was associated with lower 30- and 7-days mortality independently of triage priority whereas the opposite was observed for patients not admitted to in-hospital care. Conclusion: Prolonged ED-LOS was associated with increased short term mortality in patients with lower clinical urgency and in patients not admitted to in-hospital care.

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