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Hospital factors impact variation in emergency department length of stay more than physician factors.
West J Emerg Med. 2014 Mar; 15(2):158-64.WJ

Abstract

INTRODUCTION

To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the "door to room" interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval.

METHODS

We collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the "arrival to room" interval using simple correlation (Pearson Correlation coefficients). Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS) from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary.

RESULTS

Simple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of "door to room (waiting room time)", correlation coefficient (CC) (CC=0.000, p=0.96). "Room to doctor" had a low correlation to "door to room" CC=0.143, while "decision to admitted patients departing the ED time" had a moderate correlation of 0.29 (p <0.001). "New arrivals" (daily patient census) had a strong correlation to longer "door to room" times, 0.657, p<0.001. The "door to discharge" times had a very strong correlation CC=0.804 (p<0.001), to the extended "door to room" time.

CONCLUSION

Physician-dependent intervals had minimal correlation to the variation in arrival to room time. The "door to room" interval was a significant component to the variation in "door to discharge" i.e. LOS. The hospital-influenced "admit decision to hospital bed" i.e. hospital inpatient capacity, interval had a correlation to delayed "door to room" time. The other major factor affecting department bed availability was the "total patients per day." The correlation to the increasing "door to room" time also reflects the effect of availability of ED resources (beds) on the patient evaluation time. The time that it took for a patient to receive a room appeared more dependent on the system resources, for example, beds in the ED, as well as in the hospital, than on the physician.

Authors+Show Affiliations

Texas A&M University System Health Science Center College of Medicine, Department of Emergency Medicine, Corpus Christi, Texas.Christus Spohn Hospital, Corpus Christi, Texas.Christus Spohn Hospital, Corpus Christi, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24672604

Citation

Krall, Scott P., et al. "Hospital Factors Impact Variation in Emergency Department Length of Stay More Than Physician Factors." The Western Journal of Emergency Medicine, vol. 15, no. 2, 2014, pp. 158-64.
Krall SP, Cornelius AP, Addison JB. Hospital factors impact variation in emergency department length of stay more than physician factors. West J Emerg Med. 2014;15(2):158-64.
Krall, S. P., Cornelius, A. P., & Addison, J. B. (2014). Hospital factors impact variation in emergency department length of stay more than physician factors. The Western Journal of Emergency Medicine, 15(2), 158-64. https://doi.org/10.5811/westjem.2013.12.6860
Krall SP, Cornelius AP, Addison JB. Hospital Factors Impact Variation in Emergency Department Length of Stay More Than Physician Factors. West J Emerg Med. 2014;15(2):158-64. PubMed PMID: 24672604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital factors impact variation in emergency department length of stay more than physician factors. AU - Krall,Scott P, AU - Cornelius,Angela P, AU - Addison,J Bruce, PY - 2011/07/25/received PY - 2011/11/11/revised PY - 2013/12/19/accepted PY - 2014/3/28/entrez PY - 2014/3/29/pubmed PY - 2014/3/29/medline SP - 158 EP - 64 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 15 IS - 2 N2 - INTRODUCTION: To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the "door to room" interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval. METHODS: We collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the "arrival to room" interval using simple correlation (Pearson Correlation coefficients). Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS) from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary. RESULTS: Simple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of "door to room (waiting room time)", correlation coefficient (CC) (CC=0.000, p=0.96). "Room to doctor" had a low correlation to "door to room" CC=0.143, while "decision to admitted patients departing the ED time" had a moderate correlation of 0.29 (p <0.001). "New arrivals" (daily patient census) had a strong correlation to longer "door to room" times, 0.657, p<0.001. The "door to discharge" times had a very strong correlation CC=0.804 (p<0.001), to the extended "door to room" time. CONCLUSION: Physician-dependent intervals had minimal correlation to the variation in arrival to room time. The "door to room" interval was a significant component to the variation in "door to discharge" i.e. LOS. The hospital-influenced "admit decision to hospital bed" i.e. hospital inpatient capacity, interval had a correlation to delayed "door to room" time. The other major factor affecting department bed availability was the "total patients per day." The correlation to the increasing "door to room" time also reflects the effect of availability of ED resources (beds) on the patient evaluation time. The time that it took for a patient to receive a room appeared more dependent on the system resources, for example, beds in the ED, as well as in the hospital, than on the physician. SN - 1936-900X UR - https://www.unboundmedicine.com/medline/citation/24672604/Hospital_factors_impact_variation_in_emergency_department_length_of_stay_more_than_physician_factors_ L2 - http://escholarship.org/uc/item/79k1z6tg DB - PRIME DP - Unbound Medicine ER -