title: Delays in implementing admission orders for critical care patients associated with length of stay in emergency departments in six mid-Atlantic states.
abstract: BACKGROUND
  Every day many admitted patients wait in emergency departments for available beds or for a receiving nurse to accomplish a transfer to an inpatient bed. The purpose of this study was to examine critical care patients' length of stay and time held in the emergency department once admitted to determine if (1) holding critical care patients in emergency departments after admission was related to skilled nursing shortages and/or limitations in available resources and (2) admission orders or tests may have been overlooked during this time. Little or no literature exists on this topic.
  
  
  METHODS
  A Likert scale survey designed to yield descriptive comparative correlational data was sent to directors of critical care and emergency service areas.
  
  
  RESULTS
  Received responses totaled 109. There is a positive correlation between increased length of stay and delays in implementation of admission orders while in emergency departments and tests missed or delayed upon arrival at the critical care unit. A majority of respondents indicated that ED nursing staff had responsibility for critical care admitted patients and other patients. Few indicated a formal process or committee was in place to address this issue specific to critical care patients. Limitations included a convenience sample and variations in operations related to size, location, and culture.
  
  
  CONCLUSIONS
  Further study is necessary to determine whether patients' length of stay in the hospital is increased because of delays in plans of care and if patient outcomes are ultimately affected.
authors.affiliation: PinnacleHealth System, Harrisburg, Pa., USA. healthmart@yahoo.com
authors.forename: Karen
authors.initials: K
authors.lastname: Clark
authors.forename: Loretta Brush
authors.initials: LB
authors.lastname: Normile
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data; D003422:Critical Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008330:Management Audit; D008873:Mid-Atlantic Region; D020380:Needs Assessment; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000600:supply & distribution; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000592:standards*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D013997:Time Factors; D014768:Virginia; D014903:West Virginia