Factor associated with length of stay more than 4 hours at the Emergency Department of Vachira Phuket Hospital
Keywords:
Emergency department, Length of stay, OvercrowdingAbstract
Background: Vachira Phuket Hospital is a tertiary care hospital that suffers from emergency department overcrowding due to the large number of patients causing emergency patients receive delay treatment and are higher risks.
Objectives: The primary objective was investigating factors associated with the length of stay (LOS) more than 4 hours in the emergency department (ED). The secondary objective was to determine a correlation between LOS and mortality.
Method: This was a cross-sectional analytical study in which data were collected from the medical records of the patients visiting the ED at Vachira Phuket Hospital between 1 and 30 September 2021. Multiple logistic regression analysis was performed to determine the factors most strongly associated with ED LOS of more than 4 hours in the hospital.
Results: 1,732 patients were enrolled in this study. The median LOS was 1 hour 51 minutes. A total of 187 patients (10.8%) had ED LOS for more than 4 hours. The risk factors were the experience of the first attending physician (AOR 2.06, 95%CI 1.32-3.22), laboratory testing (AOR 3.68 for 1 round, 95%CI 2.10-6.45 and AOR 13.39 for ≥2 rounds, 95%CI 5.40-33.17), radiological investigation (AOR 1.89 for 1 round, 95%CI 1.14-3.14, and AOR 7.21 for ≥2 rounds, 95%CI 1.70-30.54), CT-scan (AOR 3.91, 95%CI 2.52-6.06), consultation to a specialist physician in ED (AOR 2.09, 95%CI 1.36-3.19), and disposition to OPD (AOR 2.30, 95%CI 1.41-3.77). Moreover, LOS of more than 4 hours at ED had an increased risk of death by 2.95-folds (95%CI 1.33-6.56).
Conclusion: The risk factors causing longer stays of patients at ED of Vachira Phuket Hospital for more than 4 hours were laboratory investigations, radiological diagnosis by computed tomography, disposition to OPD, consultation to a specialist physician, the experience of initially attending physician and radiological investigation. The proper management and correction of these factors may reduce the patient’s LOS in ED thereby reducing mortality.
References
ชาติชาย คล้ายสุวรรณ, บรรณาธิการ. คู่มือแนวทางการจัด บริการห้องฉุกเฉินที่เหมาะสมตามระดับศักยภาพสถาน พยาบาล ฉบับที่ 1 (พ.ศ. 2561). นนทบุรี: กรมการแพทย์; 2561.
Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS ONE 2018;13(8): e0203316.
Savioli G, Ceresa IF, Gri N, Piccini GB, Longhitano Y, et al. Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. J Pers Med. 2022 Feb; 12(2): 279.
Keogh B, Culliford D, Richard GL, Monks T. Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data. BMJ Open 2018;8:e020296.
Ngo H, Forero R, Mountain D, Fatovich D, Man WN, et al. Impact of the Four-Hour Rule in Western Australian hospitals: Trend analysis of a large record linkage study 2002-2013. PLoS One. 2018; 13(3): e0193902.
สำนักตรวจราชการกระทรวงสาธารณสุข กองตรวจราชการ. แผนการตรวจราชการ กระทรวงสาธารณสุข ประจำปีงบประมาณ พ.ศ. 2561. ม.ป.ท.: 2560.
Dadeh AA, Phunyanantakorn P. Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain. Emerg Med Int. 2020;2020:5406516.
Paralee P, Pearkao C. Factors Predicting Overcrowding in Emergency Room of a University Hospital. Songklanagarind J Nurs. 2020 Jun 27;40(2):52–65.
Kongkaew S, Sabaisook S, Jeanagool P, Leularp P, Petchsuk R, et al. A Situational Analysis of Waiting Times in the Emergency Department of Central Chest Institute of Thailand. Rama Med J. 2022 Oct-Dec; 45(4):45-52.
Nyce A, Gandhi S, Freeze B, Bosire J, T Ricca, et al. Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patient. Journal of Patient Experience. 2021;8:1-7.
Plongthong K, Chenthanakij B, Wittayachamnankul B, Tianwibool P, Phinyo P, et al. Factor Affecting Length of Stay More Than 6 Hours in Emergency Department. Journal of Health Systems Research 2021;15(3):381-90.
Potipadcha K, Pichedboonkiat P. Factors Related to the Length of Stay of Critically Ill Patients more than 2 Hours at the Emergency Department, Chiangrai Prachanukroh Hospital, Thailand. Journal of Emergency Medicial Services of Thailand 2022;2(1):37-46.
Thongphan T, Chantaphet C. Factors related with length of stay more than 8 hours at the Emergency Department of Bhumibol Adulyadej Hospital. CDEM journal 2020;1(1):32-39.
Verma A, Shishodia S, Jaiswal S, Sheikh WR, Haldar W, et al. Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality. Indian J Crit Care Med. 2021 Nov;25(11):1221–1225.
Kim YE, Lee HY. The effects of an emergency department length-of-stay management system on severely ill patients’ treatment outcomes. BMC Emergency Medicine. 2022;22:204.
Lauque D, Khalemsky A, Boudi Z, Östlundh L, Xu C, Alsabri M, et al. Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. J. Clin. Med. 2023;12:32.
Gurazada SG, Gao SC, Burstein F, Buntine P. Predicting Patient Length of Stay in Australian Emergency Departments Using Data Mining. Sensors. 2022 Jan;22(13):4968.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Region11Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
