title: Factors associated with longer emergency department length of stay for children with bronchiolitis : a prospective multicenter study.
abstract: OBJECTIVE
  Emergency department (ED) length of stay (LOS) is a quality of care measure and, when prolonged, contributes to ED crowding. Bronchiolitis, a common seasonal illness of infants, provides an opportunity to examine factors affecting ED LOS.
  
  
  METHODS
  We analyzed data from a 30-center prospective cohort study of ED patients younger than 2 years with an attending physician diagnosis of bronchiolitis to determine what factors affect LOS. Researchers conducted a structured interview and chart review.
  
  
  RESULTS
  Among 1459 children enrolled, ED LOS was available for 1416 children (97%). The median ED LOS was 3.3 hours (interquartile range, 2.3-4.8 hours). Multivariate analysis demonstrated that factors significantly (P < 0.05) associated with ED LOS were larger annual ED visit volume (reference, lowest tertile [< 44,134 visits], 44,134-62,420 [β = 0.74], and ≥ 62,421 [β = 0.63]), Hispanic race/ethnicity (reference, white race, β = 1.43), lack of primary care provider (β = 1.28), duration of symptoms of 4 to 7 days (reference, < 1 day; β = 0.58), presentation of midnight to 7 AM (reference, 4:00-11:59 PM; β = 1.07), decreasing lowest oxygen saturation in ED (β = 0.07), fewer number of A-agonists during the first hour (β = 0.74), unknown oral intake (reference, adequate; β = 0.69), performance of chest x-ray (β = 0.62), and hospital admission (β = 1.11).
  
  
  CONCLUSIONS
  In this prospective multicenter study of children younger than 2 years with bronchiolitis, multiple factors were associated with longer ED LOS. These factors suggest the following steps to help shorten ED LOS: optimizing translation services, improving primary care provider rates, enhancing overnight patient flow, forgoing chest x-rays, and developing evidence-based admission criteria.
authors.affiliation: Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. jonathan.mansbach@childrens.harvard.edu
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Mansbach
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Besh R B
authors.initials: BR
authors.lastname: Barcega
authors.forename: Haitham
authors.initials: H
authors.lastname: Haddad
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D001988:Bronchiolitis / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D014481:United States