Amy Sweeny1,2, Gerben Keijzers1,2,3, John O'Dwyer4, Glenn Arendts5, Julia Crilly1,2. 1. Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia. 2. Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia. 3. School of Medicine, Bond University, Gold Coast, Queensland, Australia. 4. The Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 5. Discipline of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
Abstract
BACKGROUND: Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities. AIMS: To identify predictors of a long ED length of stay (LLoS) for patients ≥65 years old. METHODS: Linked hospital information systems data from a large, public Australian ED were analysed in this retrospective cohort study. LLoS was defined as the 75th percentile (617 min). Multivariate regression identified LLoS predictors for admissions and discharges separately. RESULTS: Of 16 791 ED presentations made by older people, 4192 experienced a LLoS; 55% were admitted. Increasing age was associated with an increasing ED LoS. Factors most predictive of LLoS for both admitted and discharged patients included: investigations (both pathology and imaging), less urgent Australasian triage scale categories and after-hours arrival. Ambulance arrival did not increase the risk of a LLoS for patients eventually admitted, but conferred nearly a twofold increased risk for a LLoS for discharged older persons (adjusted odds ratios = 1.9; 95% confidence interval 1.5-2.4). CONCLUSIONS: This study assists clinicians and decision-makers to identify reasons why older persons have a LLoS, whether admitted or discharged. Interventions to streamline care for older patients arriving after-hours and who require imaging and pathology are required. LoS targets should consider age distribution. The use of ED LoS as a quality of care indicator should be assessed for admissions and discharges, separately.
BACKGROUND: Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities. AIMS: To identify predictors of a long ED length of stay (LLoS) for patients ≥65 years old. METHODS: Linked hospital information systems data from a large, public Australian ED were analysed in this retrospective cohort study. LLoS was defined as the 75th percentile (617 min). Multivariate regression identified LLoS predictors for admissions and discharges separately. RESULTS: Of 16 791 ED presentations made by older people, 4192 experienced a LLoS; 55% were admitted. Increasing age was associated with an increasing ED LoS. Factors most predictive of LLoS for both admitted and discharged patients included: investigations (both pathology and imaging), less urgent Australasian triage scale categories and after-hours arrival. Ambulance arrival did not increase the risk of a LLoS for patients eventually admitted, but conferred nearly a twofold increased risk for a LLoS for discharged older persons (adjusted odds ratios = 1.9; 95% confidence interval 1.5-2.4). CONCLUSIONS: This study assists clinicians and decision-makers to identify reasons why older persons have a LLoS, whether admitted or discharged. Interventions to streamline care for older patients arriving after-hours and who require imaging and pathology are required. LoS targets should consider age distribution. The use of ED LoS as a quality of care indicator should be assessed for admissions and discharges, separately.
Authors: Yu-Hsin Chang; Hong-Mo Shih; Jia-En Wu; Fen-Wei Huang; Wei-Kung Chen; Dar-Min Chen; Yu-Ting Chung; Charles C N Wang Journal: BMC Emerg Med Date: 2022-05-20