title: The impact of delays to admission from the emergency department on inpatient outcomes.
abstract: BACKGROUND
  We sought to determine the impact of delays to admission from the Emergency Department (ED) on inpatient length of stay (LOS), and IP cost.
  
  
  METHODS
  We conducted a retrospective analysis of 13,460 adult (>or= 18 yrs) ED visits between April 1 2006 and March 30 2007 at a tertiary care teaching hospital with two ED sites in which the mode of disposition was admission to ICU, surgery or inpatient wards. We defined ED Admission Delay as ED time to decision to admit > 12 hours. The primary outcomes were IP LOS, and total IP cost.
  
  
  RESULTS
  Approximately 11.6% (n = 1558) of admitted patients experienced admission delay. In multivariate analysis we found that admission delay was associated with 12.4% longer IP LOS (95% CI 6.6% - 18.5%) and 11.0% greater total IP cost (6.0% - 16.4%). We estimated the cumulative impact of delay on all delayed patients as an additional 2,183 inpatient days and an increase in IP cost of $2,109,173 at the study institution.
  
  
  CONCLUSIONS
  Delays to admission from the ED are associated with increased IP LOS and IP cost. Improving patient flow through the ED may reduce hospital costs and improve quality of care. There may be a business case for investments to reduce emergency department admission delays.
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada.
authors.forename: Qing
authors.initials: Q
authors.lastname: Huang
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Dreyer
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Zaric
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017598:Efficiency, Organizational / Q000191:economics* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010343:Patient Admission / Q000191:economics* / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D017749:Total Quality Management / Q000191:economics; D055815:Young Adult