Factors Affecting Emergency Department Length of Stay in Traumatic Surgical Critically Ill Patients

Kang, Kyeoung Ho; Kim, Gab Teug; Kim, Min Jung

Abstract

PURPOSE: Prolonged emergency department (ED) lengthof-stay (LOS) may cause ED overcrowding and worse outcome in traumatic surgical critically ill patients. In this study, we examined characteristics to be associated with prolonged ED LOS, including use of CT scanning and other ED-based special procedures (eg, radiologic diagnostic tests or therapeutic procedures performed in the ED).
METHODS
A retrospective cohort study was conducted at an academic medical center with 458 traumatic surgical critically ill patients from 2003 to 2004. Critical care patients were defined as those sent to the operating room (OR) or intensive care unit (ICU) directly from the ED. Information was extracted from each ED chart on use and the number of CT scanning, other special radiologic diagnostic procedures (eg, magnetic resonance imaging, angiogram, cystogram), the number of plain radiographs performed, the emergent therapeutic procedures (intubation, closed thoracotomy, central venous line), the waiting times and number of consultants called, and holding times for decision of admission. ED LOS was defined as the time from presentation until transfer to the OR or ICU. To assess the effect of multiple simultaneous factors affecting ED LOS, a Cox proportional hazard model of time-to-ED discharge was used.
RESULTS
The average overall ED LOS was 256.4+/-153.2 minutes (16 to 1465 minutes). Use of special radiologic diagnostic procedures was most strongly associated with an increased ED LOS. Use of either CT scanning or emergent therapeutic procedures, the number of plain radiographs, waiting times and numbers of consultants, and holding times for decision of admission were also affected a prolonged ED LOS independently.
CONCLUSION
ED-based patient management decisions such as use of CT and ED-based special diagnostic and therapeutic procedures strongly associated affected ED LOS in traumatic surgical critically ill patients.