Length of stay and its associated factors among adult patients who visit Emergency Department of University Hospital, Eastern Ethiopia
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ABSTRACT: Objectives:
This study was aimed to assess the length of stay and its associated factors
SUBMITTER: Fekadu G
PROVIDER: S-EPMC9373129 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundInjuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS).MethodsThis study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED.ResultsA total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18-44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3-25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38-1.88)], Amhara [AOR: 1.56, 95% CI (1.14-2.14)] and other [AOR: 3.93, 95% CI (2.73-5.64)], male [AOR: 1.30, 95% CI (1.09-1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03-1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19-4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40-3.83)] and red zones [AOR:3.37, 95% CI (2.65-4.28)]; having fracture injuries [AOR: 1.95, (1.34-2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57-4.42)].ConclusionsInjuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital's capacity to reduce prolonged LoS.
| S-EPMC11554118 | biostudies-literature
Project description:BackgroundEmergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This retrospective cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called "Diagnostic Anticipation" (DA), which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians.MethodsIn the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the DA protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. A retrospective cohort study on DA impact was conducted. Using ED electronic data, LOS independent predictors (age, sex, NEDOCS and Priority Color Code, imaging tests, specialistic consultations, hospital admission) were evaluated through multiple regression.ResultsDuring the weeks when DA was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 min for chest pain, but longer by 15.7 min for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority, specialist consultations, imaging test, hospitalization and ED crowding, the difference in visit time was significant for chest pain only (p < 0.001).ConclusionsThe impact of DA varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status.
| S-EPMC7346651 | biostudies-literature
Project description:BackgroundProlonged length of stay at the emergency department interferes with the main goal of emergency care and results in adverse patient outcomes like nosocomial infection, dissatisfaction, morbidity, and mortality. Despite this, little is known about the length of stay and the factors that influence it in Ethiopia's emergency department.MethodsAn institution-based cross-sectional study was conducted on 495 patients admitted at Amhara region comprehensive specialized hospitals emergency department from May 14 to June 15/2022. A systematic random sampling was employed to select study participants. A pretested structured interview-based questionnaire was used to collect data by using Kobo toolbox software. SPSS version 25 was used for data analysis. Bi-variable logistic regression analysis was carried out to select variables with P-value < 0.25. The significance of association was interpreted using an Adjusted Odds Ratio with a 95% confidence interval. Variables with P-value < 0.05 in the multivariable logistic regression analysis were inferred to be significantly associated with length of stay.ResultOut of 512 enrolled participants, 495 were participated with a response rate of 96.7%. The prevalence of prolonged length of stay in the adult emergency department was 46.5% (95%CI: 42.1, 51.1). Lack of insurance (AOR: 2.11; 95% CI: 1.22, 3.65), non-communicative presentation (AOR: 1.98; 95% CI: 1.07, 3.68), delayed consultation (AOR: 9.5; 95% CI: 5.00, 18.03), overcrowding (AOR: 4.98; 95% CI: 2.13, 11.68), and shift change experience (AOR: 3.67; 95% CI: 1.30, 10.37) were significantly associated with prolonged length of stay.ConclusionThe result of this study is found to be high based on Ethiopian target emergency department patient length of stay. Lack of insurance, presentation without communication, delayed consultation, overcrowding, and shift change experience were significant factors for prolonged emergency department length of stay. Therefore, interventions like expansion of organizational setup are needed to decrease the length of stay to an acceptable level.
| S-EPMC10053138 | biostudies-literature
Project description:BackgroundA prolonged length of hospital stay during heart failure-related hospitalization results in frequent readmission and high mortality. The study was aimed to determine the length of hospital stays and associated factors among heart failure patients.MethodsA prospective hospital-based cross-sectional study was carried out to determine the length of hospital stay and associated factors among heart failure patients admitted to the medical ward of the University of Gondar Comprehensive Specialized Hospital from January 2019 to June 2020. Multiple linear regression was used to identify factors associated with length of hospital stay and reported with a 95% Confidence Interval (CI). P-value ≤ 0.05 was considered as statistically significant to declare the association.ResultA total of 263 heart failure patients (mean age: 51.08 ± 19.24 years) were included. The mean length of hospital stay was 17.29 ± 7.27 days. Number of comorbidities (B = 1.494, p < 0.001), admission respiratory rate (B = -0.242, p = 0.009), serum potassium (B = -1.525, p = 0.005), third heart sound (B = -4.118, p = 0.005), paroxysmal nocturnal dyspnea (B = 2.494, p = 0.004), causes of acute heart failure; hypertensive heart disease (B = -6.349, p = 0.005), and precipitating factors of acute heart failure; infection (B = 2.867, p = 0.037) were significantly associated with length of hospital stay. Number of comorbidities, paroxysmal nocturnal dyspnea, and precipitating factors of AHF specifically infection were associated with a prolonged length of hospital stay.ConclusionHeart failure patients admitted to the medical ward had prolonged hospital stays. Thus, clinicians would be aware of the clinical features contributing to the longer hospital stay and implementation of interventions or strategies that could reduce the heart failure patient's hospital stay is necessary.
| S-EPMC9307162 | biostudies-literature
Project description:Study objectiveOur institution experienced a change in SARS-CoV-2 testing policy as well as substantial changes in local COVID-19 prevalence, allowing for a unique examination of the relationship between SARS-CoV-2 testing and emergency department (ED) length of stay.MethodsThis was an observational interrupted time series of all patients admitted to an academic health system between March 15, 2020, and September 30, 2020. Given testing limitations from March 15 to April 24, all patients receiving SARS-CoV-2 tests were symptomatic. On April 24, testing was expanded to all ED admissions. The primary and secondary outcomes were ED length of stay and number needed to test to obtain a positive, respectively.ResultsA total of 70,856 patients were cared for in the EDs during the 7-month period. The testing change increased admission length of stay by 1.89 hours (95% confidence interval 1.39 to 2.38). The number needed to test was 2.5 patients and was highest yield on April 1, 2020, when the state positivity rate was 39.7%; however, the number needed to test exceeded 170 patients by Sept 1, 2020, at which point the state positivity rate was 0.5%.ConclusionAlthough universal SARS-CoV-2 testing of ED admissions may meaningfully support mitigation and containment efforts, the clinical cost of testing all admissions amid low community positivity is notable. In our system, universal ED SARS-CoV-2 testing was associated with a 24% increase in admission length of stay alongside the detection of only 1 positive case every other day. Given the known harms and risks of ED boarding and crowding, solutions must be developed to support regular operational flow while balancing infection prevention needs.
| S-EPMC8424016 | biostudies-literature
Project description: Not available
| S-EPMC1184244 | biostudies-literature
Project description:BackgroundEmergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke.MethodsThis study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score >2), respectively.ResultsThe median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n = 160) versus the neuroscience intensive care unit (NICU; n = 165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P <.001), endovascular stroke therapy (P = .001), and thrombolysis (P = .021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P = .048). On multivariable logistic regression, a greater admission National Institutes of Health Stroke Scale score (P <.001), worse preadmission mRS score (P = .001), hemorrhagic conversion (P = .041), and a shorter ED-LOS (P = .016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P = .049), endovascular stroke therapy (P = .041), NICU admission (P = .029), and evening shift presentation (P = .035) were associated with a good 90-day outcome.ConclusionsIn contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk of a poor functional outcome.
| S-EPMC5600670 | biostudies-literature
Project description:BackgroundThe duration between a patient's arrival at the Emergency Department (ED) and their actual departure, known as the Emergency Department Length of Stay (EDLOS), can have significant implications for a patient's health. In Ethiopia, various studies have investigated EDLOS, but a comprehensive nationwide pooled prevalence of prolonged EDLOS, which varies across different locations, is currently lacking. Therefore, the objective of this systematic review and meta-analysis is to provide nationally representative pooled prevalence of prolonged EDLOS and identify associated factors.MethodsIn this study, we conducted a comprehensive systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. We conducted a thorough search of numerous international databases, including PubMed/Medline, SCOPUS, Web of Science, and Google Scholar. The primary outcome was the prevalence of prolonged EDLOS. The secondary outcome was factors affecting the EDLOS. Random-effects model was used to since there was high heterogeneity. We also conducted subgroup analysis and meta-regression to investigate heterogeneity within the included studies. To assess publication bias, we used Egger's regression test and funnel plots. All statistical analyses were performed using STATA version 17.0 software to ensure accurate and reliable findings.ResultWe have identified eight articles that met our inclusion criteria with a total sample size of 8,612 participants. The findings of this systematic review and meta-analysis indicate that the pooled estimate for the prevalence of prolonged EDLOS is 63.67% (95% CI = 45.18, 82.16, I2 = 99.56%, P = 0.0001). The study identified several significant factors associated with prolonged EDLOS, including patients admitted to overcrowded emergency departments (OR = 5.25, 95% CI = 1.77, 15.58), delays in receiving laboratory findings (OR = 3.12, 95% CI = 2.16, 4.49), and delays in receiving radiological results (OR = 3.00, 95% CI = 2.16, 4.16).ConclusionIn this review, the EDLOS was found to be very high. Overcrowding, delays in laboratory test findings, and delays in radiology test results make up the factors that have a statistically significant association with prolonged EDLOS. Given the high prevalence of prolonged EDLOS in this review, stakeholders should work to increase the timeliness of ED services in Ethiopia by proper disposition of non-emergency palliative patients to the appropriate destination, and implementing point-of-care testing and imaging.
| S-EPMC11559234 | biostudies-literature
Project description:The effect of emergency department (ED) length of stay (EDLOS) on in-hospital mortality (IHM) remains unclear. The aim of this systematic review and meta-analysis was to determine the association between EDLOS and IHM. We searched the PubMed, Medline, Embase, Web of Science, Cochrane Controlled Register of Trials, CINAHL, PsycInfo, and Scopus databases from their inception until 14-15 January 2022. We included studies reporting the association between EDLOS and IHM. A total of 11,337 references were identified, and 52 studies (total of 1,718,518 ED patients) were included in the systematic review and 33 in the meta-analysis. A statistically significant association between EDLOS and IHM was observed for EDLOS over 24 h in patients admitted to an intensive care unit (ICU) (OR = 1.396, 95% confidence interval [CI]: 1.147 to 1.701; p < 0.001, I2 = 0%) and for low EDLOS in non-ICU-admitted patients (OR = 0.583, 95% CI: 0.453 to 0.745; p < 0.001, I2 = 0%). No associations were detected for the other cut-offs. Our findings suggest that there is an association between IHM low EDLOS and EDLOS exceeding 24 h and IHM. Long stays in the ED should not be allowed and special attention should be given to patients admitted after a short stay in the ED.
| S-EPMC9821325 | biostudies-literature
Project description:BackgroundProlonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU).MethodsWe conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality.ResultsBetween 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9-6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16-1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level.ConclusionsIn this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.
| S-EPMC9677700 | biostudies-literature